改良环甲膜切开术在重症OSAHS多平面手术治疗中的应用  

Application of modified cricothyrotomy in the multiplane surgery for severe obstructive sleep apnea hypopnea syndrome

作　　者：张鑫[1] 刘业海[1] 吴静[1] 高潮兵[1] 赵益[1] 王杨[1] 汪东[1] ZHANG Xin;LIU Yehai;WU Jing;GAO Chaobing;ZHAO Yi;WANG Yang;WANG Dong(Department of Otolaryngology Head and Neck Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei,230022,China)

机构地区：[1]安徽医科大学第一附属医院耳鼻咽喉头颈外科,合肥230022

出　　处：《临床耳鼻咽喉头颈外科杂志》2018年第22期1727-1730,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨改良环甲膜切开术在重症OSAHS多平面手术治疗中的临床应用价值。方法:回顾性分析20例改良环甲膜切开术在重症OSAHS同期行多平面手术患者的临床资料。20例手术治疗的患者首先经口插入插管全身麻醉,全身麻醉生效后行改良环甲膜切开术,最后完成多平面手术。结果:本组20例患者术毕全部回普通病房,未进ICU病房;全部患者未出现颈部皮下气肿;1例气管造口少许出血;气管套管拔管时间为术后5～10d;术后3个月复诊,20例中19例气管切开横切口愈合佳,切口不明显,1例术后术后瘢痕由于粘连牵拉不满意。随诊6个月,患者手术效果皆满意。结论:改良环甲膜切开术易于操作,且较安全,术后并发症少,切口不明显,尤其为行多平面手术治疗重症OSAHS的患者提供了安全保障。Objective：To explore the clinical value of modified cricothyrotomy in the multiplane surgery under general anesthesia for patients with severe obstructive sleep apnea hypopnea syndrome（OSAHS）.Method：A retrospective review was made among 20 cases with severe OSAHS treated a concurrent multiplane surgery under the condition of modified cricothyrotomy with general anesthesia,performed during recent 3 years,with their clinical data reviewed carefully.General anesthesia was carried out by inserting trachea cannula through mouth at first,and then,modified cricothyrotomy was performed via a transverse incision,followed by pulling out trachea cannula and inserting endotracheal tube through thyrocricoid incision.After this procedure,a multiplane operation was done under such a condition to treat severe OSAHS concurrently.Result：All these patients were sent back to the general ward instead of ICU after the operation,with no cervical subcutaneous emphysema occured,and one case of them bled slightly from the cervical incision during the period of hospital.Tracheal tube was pulled out successfully among these cases within 5 to 10 days.By the end of following up period for 3 months,all cervical incision of them recovered well except a dissatisfied patient due to adhesion and pull of the cervical cicatrice.After six months of follow-up,all patients were satisfied with their surgery and rehabilitation efficacy.Conclusion：Modified cricothyrotomy is easy and safe to perform,with few complications occurring and inconspicuous postoperative scar in the region of incision.Such a procedure may ensure the concurrent multiplane operation on cases with severe OSAHS performed safely as possible as it can.

关 键 词：改良环甲膜切开术 睡眠呼吸暂停低通气综合征 阻塞性 多平面手术 

分 类 号：R563.8[医药卫生—呼吸系统]