Phookan Jyotirmoy, Talukdar Rakesh, Das Hirak Jyoti, Saikia Nabajyoti, Mili Mohan Kr, Gohain Mridusmita
Department of ENT, Assam Medical College and Hospital, Dibrugarh, Assam 786002 India.
Indian J Otolaryngol Head Neck Surg. 2022 Oct;74(Suppl 2):2153-2159. doi: 10.1007/s12070-020-02021-6. Epub 2020 Aug 18.
Cut neck injury needs prolonged hospitalization, high cost care, reduced quality of life and above all death. Proper exploration is a must in preventing co-morbidities like shock, sepsis, laryngotracheal stenosis or fistula formation. Neck trauma can involve muscles, vessels, nerves, bone and hollow viscera. Though the repair of neck means planning and skill for repair of the structure, the tracheal repair needs special attention to avoid tracheal stenosis. 12 patients were included in the prospective study of 8 months. Management plan was undertaken which were thoroughly studied and discussed with respect to two tracheoplasty cases done in ENT OT, AMCH. Apart from haemodynamic stability all patients were assessed for injury to hollow viscera and planned accordingly as this centre is an important centre for airway reconstruction. Male female ratio was 11:1. Suicidal cut neck injury was the most common cause. Two cases were of tracheal stenosis post tracheostomy. One of the case had associated neurovascular injury but with patent airway. Rest of the cases were repaired under general and/or local anaesthesia. Primary aim should be to maintain airway and to look for the extent of injury to reduce morbidity. Expertise of surgeons' skill is developing every day hence the successfulness of repair will be tested by least of morbidity. From this institute which is skilled in airway reconstruction we could comment that airway reconstruction team should be an integral part of surgeons' team.
割颈伤需要长期住院、高额护理费用、生活质量下降,最重要的是会导致死亡。进行恰当的探查对于预防诸如休克、脓毒症、喉气管狭窄或瘘管形成等并发症是必不可少的。颈部创伤可累及肌肉、血管、神经、骨骼和中空脏器。虽然颈部修复意味着对结构修复的规划和技巧,但气管修复需要特别注意以避免气管狭窄。在为期8个月的前瞻性研究中纳入了12例患者。制定了管理计划,并就阿姆利则医学学院耳鼻喉科手术室进行的两例气管成形术病例进行了深入研究和讨论。除了血流动力学稳定外,所有患者均评估了中空脏器损伤情况并据此制定计划,因为该中心是气道重建的重要中心。男女比例为11:1。自杀性割颈伤是最常见的原因。两例为气管切开术后气管狭窄。其中一例伴有神经血管损伤,但气道通畅。其余病例在全身和/或局部麻醉下进行修复。首要目标应是维持气道并查明损伤程度以降低发病率。外科医生的技术专长每日都在发展,因此修复的成功率将通过最低发病率来检验。从这个擅长气道重建的机构我们可以评论说,气道重建团队应是外科医生团队不可或缺的一部分。