Toursarkissian B, Fowler C L, Zweng T N, Kearney P A
Department of Surgery, University of Kentucky Medical Center, Lexington 40536-0084.
J Pediatr Surg. 1994 Nov;29(11):1421-4. doi: 10.1016/0022-3468(94)90135-x.
Percutaneous dilational tracheostomy (PDT) is a new technique that has been successfully performed in adult patients who required long-term mechanical ventilation, but it has not been used in children. The authors report their initial experience with PDT in 11 children and teenagers. The procedure is as follows. Using Seldinger's technique, the trachea is cannulated with a guide-wire. It is then progressively dilated, to an appropriately sized tract, with dilators from a commercially available kit. Then, a tracheostomy tube can be inserted into the trachea, loaded over a dilator. Eleven children, aged 10 to 20 years, underwent PDT in an average of 20 minutes. In eight cases, PDT was performed at the bedside. One intraoperative and one postoperative complication developed in the same patient; both complications were easily recognized and treated. Tracheal stenosis has not developed in eight decannulated patients at an average of 43 +/- 30 weeks after decannulation. PDT appears to be a safe, potentially cost-effective alternative to open tracheostomy in young patients.
经皮扩张气管切开术（PDT）是一项新技术，已成功应用于需要长期机械通气的成年患者，但尚未用于儿童。作者报告了他们对11名儿童和青少年进行PDT的初步经验。手术步骤如下。采用Seldinger技术，用导丝插入气管。然后使用市售套件中的扩张器将其逐步扩张至合适大小的通道。接着，可将气管切开管套在扩张器上插入气管。11名年龄在10至20岁的儿童平均在20分钟内接受了PDT。8例在床边进行了PDT。同一患者发生了1例术中并发症和1例术后并发症；两种并发症均易于识别和处理。8例拔管患者在拔管后平均43±30周未发生气管狭窄。对于年轻患者，PDT似乎是一种安全且可能具有成本效益的开放性气管切开术替代方法。
