Booka Eisuke, Takeuchi Hiroya, Kikuchi Hirotoshi, Miura Akinori, Kanda Mitsuro, Kawaguchi Yoshihiko, Hamai Yoichi, Nasu Motomi, Sato Shinsuke, Inoue Masazumi, Okubo Keisuke, Ogawa Ryo, Sato Hiroshi, Yoshino Shigefumi, Takebayashi Katsushi, Kono Koji, Toh Yasushi, Katori Yukio
Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu, Shizuoka, 431-3192, Japan.
Department of Esophageal Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
Esophagus. 2025 Jan;22(1):19-26. doi: 10.1007/s10388-024-01082-8. Epub 2024 Sep 6.
Cricothyrotomy is a widely performed potentially life-saving treatment to secure an airway in emergencies. It is also a pneumonia-preventing treatment to secure an expectorant route in patients with difficulty self-expelling sputum; however, its safety and usefulness remain unclear. Thus, we conducted a nationwide survey of cricothyrotomy.
We retrospectively collected and analyzed cricothyrotomy data from the institutions certified by the Japan Broncho-Esophagological Society or the Japanese Esophageal Society. Ultimately, 116 facilities responded to the survey and the present study included 1001 patients from 26 facilities who underwent cricothyrotomies from January 1, 2010 to December 31, 2021.
Cricothyrotomy was performed for sputum suctioning after esophagectomy or other surgical procedures in 945 (94.4%) cases and for emergency airway clearance in 48 (4.8%) cases. Complications during puncture were observed in 12 (1.2%) cases. We found significantly fewer complications during puncture for sputum suction (1.0%) compared with emergency airway clearance (4.2%) (p = 0.002), and also at the condition after esophagectomy (0.5%) compared with other surgical procedures (7.8%) (p < 0.001). Complications after puncture were observed in 45 (4.5%) cases, and we found significantly fewer complications after puncture at the condition after esophagectomy (4.2%) compared with other surgical procedures (11.8%) (p = 0.032). There were no significant differences in the type of kit used for complications during and after the puncture.
Cricothyrotomy for prophylactic sputum suctioning after esophagectomy was safer compared to emergency airway clearance. However, future studies should verify the efficacy of cricothyrotomy.
环甲膜切开术是一种广泛应用的、可能挽救生命的治疗方法，用于在紧急情况下确保气道通畅。它也是一种预防肺炎的治疗方法，用于帮助咳痰困难的患者确保排痰途径；然而，其安全性和有效性仍不明确。因此，我们在全国范围内开展了一项环甲膜切开术调查。
我们回顾性收集并分析了日本支气管食管学会或日本食管学会认证机构的环甲膜切开术数据。最终，116家机构回复了调查，本研究纳入了2010年1月1日至2021年12月31日期间在26家机构接受环甲膜切开术的1001例患者。
945例（94.4%）环甲膜切开术用于食管切除术后或其他外科手术后的吸痰，48例（4.8%）用于紧急气道清理。穿刺过程中出现并发症的有12例（1.2%）。我们发现，与紧急气道清理（4.2%）相比，吸痰穿刺过程中的并发症明显更少（1.0%）（p = 0.002），与其他外科手术（7.8%）相比，食管切除术后的并发症也更少（0.5%）（p < 0.001）。穿刺后出现并发症的有45例（4.5%），我们发现与其他外科手术（11.8%）相比，食管切除术后穿刺后的并发症明显更少（4.2%）（p = 0.032）。穿刺期间和穿刺后并发症所使用套件的类型没有显著差异。
与紧急气道清理相比，食管切除术后预防性吸痰的环甲膜切开术更安全。然而，未来的研究应验证环甲膜切开术的疗效。
