Fantoni A, Ripamonti D, Lesmo A, Zanoni C I
Divisione di Anestesia e Rianimazione, Azienda Ospedaliera, Ospedale San Carlo Borromeo, Milano.
Minerva Anestesiol. 1996 Oct;62(10):313-25.
Presentation of a new technique of dilation tracheostomy projected to offer a minimum risk of complication and tissue trauma.
Prospective study carried out between July 1993 and December 1995, to evaluate the feasibility of the procedure, its possible advantages over other methods, and possible complications.
General ICU with a Paediatrics Section.
Uninterrupted series of 84 adults and 12 children with multifactorial respiratory insufficiency.
Through a needle inserted in the trachea, a guide wire is retrogradely pushed out of the mouth and attached to a special device formed by a flexible plastic cone with pointed metal tip joined to an armoured tracheal cannula. This device is then pulled back through the oral cavity, larynx, trachea-hence the definition: TransLaryngeal Tracheostomy (TLT)- and outwards across the neck wall by applying traction on the wire with one hand and counterpressure on the neck wall with the fingers of the operator's other hand. When the cone and part of the cannula have emerged, the cone is separated from the cannula. The cannula is further extracted until its inside portion can be turned downwards to its final placement.
A precise localisation of the stoma placement and the needle introduction are facilitated by the rigid tracheoscope and protrusion. Thanks to the very pointed cone, the piercing resistances are lowered. At the same time, every degree of traction power is allowed through the counterpressure practised by the fingers. The channel is very regular with a strong adherence to the cannula that secures a virtual lack of bleeding and local inflammation. We observed this in the fifty cases, in which the final version of our technique was applied. Trachea CT scan and endoscopic control did not show late lesions of the airway.
TLT is characterised by highest inherent safety and lowest tissue traumatism, that it can also be performed in patients who would risk complications from any other tracheostomy techniques.
介绍一种新型扩张气管切开术，旨在将并发症风险和组织创伤降至最低。
1993年7月至1995年12月进行的前瞻性研究，以评估该手术的可行性、其相对于其他方法的可能优势以及可能的并发症。
设有儿科科室的综合重症监护病房。
84名成人和12名儿童组成的连续系列，均患有多因素呼吸功能不全。
通过插入气管的针，将导丝逆行推出口腔并连接到一个特殊装置上，该装置由一个带有尖金属尖端的柔性塑料圆锥体和一个铠装气管套管连接而成。然后，通过一只手拉动导丝并由操作者另一只手的手指对颈部壁施加反压力，将该装置通过口腔、喉部、气管拉回——因此得名：经喉气管切开术（TLT）——并穿过颈部壁向外拉出。当圆锥体和部分套管露出时，将圆锥体与套管分离。进一步拔出套管，直到其内部部分可以向下翻转至最终位置。
硬质气管镜和突出物有助于精确确定造口位置和进针位置。由于圆锥体非常尖锐，降低了穿刺阻力。同时，通过手指施加的反压力可以实现各种程度的牵引力。通道非常规则，与套管紧密贴合，确保几乎没有出血和局部炎症。在应用我们技术最终版本的50例病例中我们观察到了这一点。气管CT扫描和内镜检查未显示气道晚期病变。
经喉气管切开术的特点是固有安全性最高和组织创伤最小，它也可用于任何其他气管切开术技术可能导致并发症的患者。
