Lipkin A F, Christopher K L, Diehl S, Yaeger E S, Jorgenson S
Swedish Medical Center, Englewood, Colorado, USA.
Otolaryngol Head Neck Surg. 1996 Nov;115(5):447-53. doi: 10.1177/019459989611500516.
The modified Seldinger technique for transtracheal oxygen catheter insertion is relatively straightforward, but tract problems during subsequent oxygen therapy are not uncommon. With the modified Seldinger technique method, transtracheal oxygen is not initiated until 1 week after the procedure. Six to 8 weeks are required for tract epithelialization, which allows routine catheter removal and cleaning by the patient. Without removal, mucus tends to collect and form balls on the catheter tip, creating a management problem. Previous studies suggest a significant incidence of tracheal chondritis, keloid formation, and inadvertent catheter dislodgment. In 7% to 10% of patients, the epithelial tract cannot be recovered by medical personnel, and complete closure occurs. We have developed a surgical technique for the creation of a controlled tracheocutaneous tract. Highlights of the minitrach include skin flap elevation, cervical lipectomy, resection of a small window of tracheal cartilage, and approximation of the skin flaps to the window. We evaluated 33 patients who underwent the minitrach procedure as an access method for receiving transtracheal oxygen. When compared with results from 64 patients followed up for a similar period with the modified Seldinger technique, results with minitrach showed that transtracheal oxygen could be instituted sooner (<24 hours), and symptomatic mucus balls were reduced because the tract matured more quickly (approximately 14 days). With the minitrach there were no inadvertent catheter dislodgments, as compared with 41% of modified Seldinger technique patients who had one or more episodes of catheter dislodgment. Twelve percent of minitrach patients had a single episode of chondritis, as compared with 25% of the modified Seldinger technique patients, who had one or more episodes. The minitrach was well tolerated in this group of patients with severe pulmonary and/or cardiovascular disease. In 12 of these patients, a minitrach revision of their previous modified Seldinger technique tracts resolved recurrent problems with chondritis, lost tracts, and keloids. We conclude that the minitrach promotes early institution of transtracheal oxygen, simplifies an intense postprocedure educational and management process, facilitates tract maturation, and reduces the incidence of problems related to mucus balls, lost tracts, chondritis, and keloids. The minitrach can be used as a revision procedure to resolve tract problems encountered with modified Seldinger technique. We are now using the minitrach as the preferred procedure for the institution of transtracheal oxygen. The minitrach greatly improves and simplifies the transtracheal oxygen program, and the otolaryngologist becomes an important member of the transtracheal oxygen team.
改良塞丁格技术用于经气管氧导管插入相对简单，但在随后的氧疗过程中出现通道问题并不罕见。采用改良塞丁格技术时，术后1周才开始经气管给氧。通道上皮化需要6至8周时间，这使得患者能够常规取出和清洁导管。如果不取出，黏液往往会在导管尖端聚集并形成球状物，造成管理难题。以往研究表明，气管软骨炎、瘢痕疙瘩形成及导管意外移位的发生率较高。7%至10%的患者，医务人员无法恢复上皮通道，通道会完全闭合。我们已开发出一种创建可控气管皮肤通道的手术技术。微型气管造口术的要点包括皮瓣掀起、颈部脂肪切除术、切除一小片气管软骨以及将皮瓣与窗口贴合。我们评估了33例行微型气管造口术作为接受经气管给氧途径的患者。与64例采用改良塞丁格技术并随访相似时间的患者结果相比，微型气管造口术的结果显示经气管给氧可更早开始（<24小时），且由于通道成熟更快（约14天），有症状的黏液球减少。采用微型气管造口术未出现导管意外移位情况，而采用改良塞丁格技术的患者中有41%发生过一次或多次导管移位。微型气管造口术患者中有12%发生过单次软骨炎，而采用改良塞丁格技术的患者中有25%发生过一次或多次软骨炎。在这组患有严重肺部和/或心血管疾病的患者中，微型气管造口术耐受性良好。其中12例患者对其先前采用改良塞丁格技术形成的通道进行微型气管造口术修复，解决了软骨炎、通道丢失和瘢痕疙瘩等反复出现的问题。我们得出结论，微型气管造口术可促进经气管给氧的早期实施，简化术后繁琐的教育和管理过程，促进通道成熟，并降低与黏液球、通道丢失、软骨炎和瘢痕疙瘩相关问题的发生率。微型气管造口术可用作修复手术，以解决改良塞丁格技术遇到的通道问题。我们现在将微型气管造口术作为实施经气管给氧的首选方法。微型气管造口术极大地改善和简化了经气管给氧方案，耳鼻喉科医生成为经气管给氧团队的重要成员。
