预防性横行气管切开在重症气管狭窄切除重建术中的应用  

Application of prophylactic transverse tracheotomy in tracheal resection and reconstruction for critical patient with tracheal stenosis

作　　者：蔡奕欣[1] 付向宁[1] 张霓[1] 徐沁孜[1] 付圣灵[1] 张瑞杰[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院胸外科,武汉430030

出　　处：《临床外科杂志》2014年第12期942-944,共3页Journal of Clinical Surgery

摘　　要：目的：探讨预防性横行气管切开对气管狭窄切除重建术后呼吸道管理及减小吻合口张力的价值。方法22例气管狭窄患者均施行气管病变段切除并对端吻合重建手术，根据是否手术同期接受横行切口气管切开，分为气管切开组10例和非气管切开组12例。分析比较两组患者临床资料。结果气管切开组患者术前CPIS评分（临床肺部感染评分）、声嘶、意识障碍比率均明显高于非气管切开组（P＜0．05），全组患者无死亡，两组手术时间、手术出血量、术后呼吸机使用时间、ICU监护时间、抗生素使用时间以及术后ARDS、吻合口瘘等并发症发生率均无明显差异。术后随访22例，随访时间3～32个月，均日常活动正常，无呼吸困难症状，三维CT重建检查无气管狭窄。结论气管切除重建术后行预防性横行气管切开，简化了术后的气道管理，保证了气道的通畅与清洁，同时亦起到减小吻合口张力作用，有效地减少术后并发症，对于气管狭窄重症患者，推荐预防性气管切开。Objective To evaluate the values of airway management and tension relief in prophylactic transverse tracheotomy after tracheal resection and reconstruction for critical patient of tracheal stenosis.Methods The clinical data of22 patients with tracheal stenosis who received tracheal resection andendtoend reconstruction were retrospectively analyzed,including 10 cases with tracheotomy and 12 caseswithout it.Results The clinical pulmonary infection score（CPIS）and ratio of hoarseness and unconsciousness in the tracheotomy group were significantly higher than those of the nontracheotomy group（P 〈0.05）.No inhospital death occurred.There were no significant differences in operation time,intraoperative blood loss,mechanical ventilation duration,ICU hospitalization and the incidence of ARDS andanastomotic fistula between the two groups.Followup time ranged from 3 to 32 months.All patients can achieve normal daily activities without dyspnea complain.Postoperative CT reconstruction showed no tracheal stenosis.Conclusion After tracheal resection and reconstruction,prophylactic transverse tracheotomycan simplify airway management,ensure cleanses,relieve the tension of anastomosis and reduce postoperative complications,which is recommended in critical patient with tracheal stenosis.

关 键 词：气管狭窄 重建术 预防性气管切开 横行切口 

分 类 号：R655[医药卫生—外科学]