喉全切除术后气管造瘘口狭窄

喉癌是耳鼻咽喉头颈外科常见的恶性肿瘤，喉全切除是治疗中晚期喉癌的最有效办法。喉全切除后要在颈部进行气管造瘘，气管造瘘口狭窄是术后常见的并发症之一，本文就喉全切除术后气管造瘘口狭窄的诊断、病因学及治疗学研究进展作一综述。     

气管切开扩大适应证与手术的安全性

作为一名耳鼻咽喉 头颈外科医师 ,掌握气管切开的各种适应证及时机 ,对保证手术的顺利进行和提高手术的安全性非常重要。为了较全面阐述气管切开术的适应证 ,现对中国医学科学院肿瘤医院头颈外科和安徽医科大学第一附属医院耳鼻咽喉 头颈外科近两年来所行的气管切开术进行详细分析 ,报告如下。1　材料与方法2 0 0 0年 1月～ 2 0 0 1年 1 0月 ,共行气管切开术35 1例 ,男 2 0 8例 ,女 1 43例 ;最大年龄 85岁 ,最小6个月。 35 1例中 ,按教科书所述的适应证 2 92例 ,其中喉梗阻 1 1 6例 ,下呼吸道分泌物阻塞 80例 ,头颈部外伤 1 1例 ,先行气管切…     

新型冠状病毒肺炎疫情下气道改道患者的气道防护措施

目的讨论新型冠状病毒肺炎疫情期间,对气道改道患者（气管切开术后或全喉切除气管造瘘）的气道防护措施。方法随访2018年1月—2019年12月在湘雅二医院耳鼻咽喉头颈外科行气管切开术未拔管及全喉切除气管造瘘患者122例,并在2020年1月22日—2020年2月18日疫情期通过建立微信群和电话随访方式对患者进行针对性的气道防护及宣教,收集患者日常活动信息及身体状况信息。结果截止至2020年2月18日,122例随访患者均未出现确诊病例。结论在呼吸道传染病疫情期间对气道改道患者进行针对性的气道防护指导,可以有效的降低此类患者的被感染率。     

困难气管切开的原因和治疗策略

气管切开术是耳鼻咽喉头颈外科常见及常规手术之一,其功能已从单纯解除气道阻塞的急诊手术发展成为辅助脑外科、胸外科、神经内科及用于机械通气支持等的预防性手术。多数情况下,接受常规训练的医师均能顺利实施和完成气管切开术,但在临床实际工作中,仍有部分患者由于各种原因,出现气管切开困难或失败,若不能及时正确处理,往往会导致患者死亡等严重后果。因此,对困难气管切开应保持清醒的认识和高度的重视,以最大限度避免和减少意外情况的发生。本文就困难气管切开的原因和治疗策略做一综述。     

合并困难气道头颈外科手术的麻醉选择

目的探讨头颈手术困难气道的麻醉选择。方法回顾性分析2012年1月到2016年8月安徽医科大学第一附属医院耳鼻咽喉头颈外科收治86例困难气道头颈手术的临床资料。在86例手术中,采取了4种不同类型麻醉方式,方法一:10例行喉罩全麻。方法二:21例在表面麻醉下借助可视喉镜先行气管插管,再行气管切开术,方法三:54例在面罩给氧的情况下,直接行气管切开术,在气切口插入麻醉插管,方法四:另有一例,与胸外科联合,用体外循环技术解决困难气道。结果 6例患者均成功麻醉,完成头颈部手术,其中3例术后第二天开始出现皮下气肿,未特殊处理,气肿渐消退。2例出现气管造口出血,反复凡士林压迫止血后,效果不佳,打开术腔后,结扎止血.1例术后出现气胸请胸外科紧急行闭式胸腔引流术。1例卢德维氏颈炎患者因感染性休克死亡。其余患者未出现呼吸心跳骤停、大出血等严重并发症。结论对于合并有困难气道的头颈手术,采用适宜的麻醉方式,是确保病人度过麻醉手术期的关键。     

气管食管科学

200951气管切开并发症发生机制临床解剖学分析—附307例并发症报告/陈合新…刀中国耳鼻咽喉颅底外科杂志一1999,5(3)一1 66一168 目的:探讨气管切开术并发症的发生机制和预防措施。方法:总结1977年8月一1997年12月期间2991例气管切开病例中307例并发症情况,并从解剖学角度探讨不同并发症的发生机制。结果:总发生率为10.3%(307/2991);307例并发症中,出血、皮下气肿、纵隔气肿、气胸、喉狭窄和气管食管漏发生率分别为4.3%、3.6%、0.8%、0.7%、0.1%和。.03%。结论:临床医师应熟悉该手术的解剖特点,以减少并发症的发生。表1参8(秦斯)200952闭合…     

气管食管科学

20010554外伤性颈段高位食管气管痰3例报告/路虹…//耳鼻咽喉一头颈外科一2。。o,7(4)一24320010555置‘,T”形硅胶管不当所致气管狭窄/沈昌德…//耳鼻咽喉一头颈外科一2000,7(4)一247200105“’脑卒中急性期气管切开术应用的探讨/憔凤英…//中国中西医结合耳鼻咽喉科杂志一2000,8(4)一184~186 目的:为了提高脑卒中病人抢救成功率,减少并发症。方法:采用回顾性研究的方法,总结分析138例脑卒中急性期气管切开治疗的临床资料。结果:发现本组96例(7D%)及时气管切开抢救成功;42例(30%)因手术时机选择不当病变严重或发生并发症而死亡。同时分析…     

可视喉镜下梨状窝瘘内口低温等离子封闭术的初步探讨

目的:探讨可视喉镜下梨状窝瘘内口低温等离子封闭术的手术效果.方法:回顾性分析2019年3月-2021年8月在南京医科大学附属儿童医院耳鼻咽喉头颈外科行可视喉镜下梨状窝瘘内口低温等离子封闭术的29例先天性梨状窝瘘患儿的临床资料.19例行梨状窝瘘探查十瘘口封闭术,6例行梨状窝瘘探查十瘘口封闭术十颈部脓肿切开引流,4例颈部质...     

耳鼻咽喉头颈外科住院总医师在进修生继续教育中的作用

耳鼻咽喉头颈外科的专科特点决定了进修生继续教育的必要性,而耳鼻咽喉头颈外科住院总医师的职责又决定了其在进修生继续教育中的桥梁和纽带作用,主要表现在住院总医师可以更合理的为进修生安排科内讲座;更大程度的激发进修生的学习主动性;更全面的为进修生分配床位、安排一线值班;更好地规范进修生的病历书写;更多的使用手术室数字化多媒体提高进修生的学习效率。实践证明,重视住院总医师在耳鼻咽喉头颈外科进修生继续教育中的作用,对科室的教学和临床工作具有一定的作用,值得推广借鉴。     

能力,安全,质量——21世纪医学途径

前记2007年10月,美国外科医师学院在新奥尔良召开了第93届临床外科会议。本届会议的主席是美国小儿耳鼻咽喉头颈外科专家Gerald B Healy教授。这是美国外科医师学院88年来第一次由耳鼻咽喉头颈外科医师担任主席,这说明耳鼻咽喉头颈外科已经成为外科的重要组成部分。回顾半个多世纪以来,耳鼻咽喉科从一个被当时一些外科医师轻视的学科发展到今天的规模,     

Surgical complications of bedside tracheotomy in an otolaryngology residency program

A prospective analysis of 124 consecutive adult patients undergoing tracheotomy was performed to examine the incidence of resulting complications. All tracheotomies were performed by a junior otolaryngology resident under the supervision of a member of the attending staff or a chief resident. The vast majority were performed at the bedside in an intensive care unit. The complications were divided into two groups: early (within 2 days) and late (2 to 14 days). Seven patients had complications directly related to tracheotomy. Four of these complications occurred in three patients and were considered significant. There were no mortalities. Despite the fact that our tracheotomies were routinely performed by residents at the bedside, our complication rate was comparable to those reported from other centers. We believe that bedside tracheotomy, properly supervised and performed, is a safe procedure.     

耳鼻咽喉科住院总医师1062例会诊病例分析

目的:分析耳鼻咽喉科住院总医师会诊患者的构成特点,从一个侧面反映住院总医师的工作情况。方法:统计第四军医大学西京医院耳鼻咽喉科1名住院总医师在2005年6月1日~2006年3月15日会诊的患者。结果:会诊患者共计1 062例,平均每周新会诊28例。其中急症会诊467例(43.97%),常规会诊595例(56.03%)。急症会诊的患者构成:鼻出血最多,共279例,占急症会诊总数的59.72%,病因主要为凝血机制障碍、高血压、肝肾功能衰竭、外伤等,少数为医源性诱发。喉阻塞及气管切开术113例,占急症会诊的24.19%,位于第2位。气管和支气管异物43例,病情均较危重。内科请常规会诊以炎症性疾病最多,慢性鼻炎及鼻窦炎169例,慢性咽炎及急慢性扁桃体炎162例,注意检查与诊断的全面性。外科因术前准备请耳鼻咽喉科常规会诊67例,目的是围手术期耳鼻咽喉科疾病风险评价和预防。结论:会诊工作具有特殊性和挑战性,住院总医师应该了解会诊患者特点,在会诊中学习和积累经验。     

Appropriateness of routine postoperative chest radiography after tracheotomy

OBJECTIVE: To determine the appropriateness of postoperative chest radiography after adult tracheotomy. DESIGN: Retrospective case series. SETTING: Tertiary care academic medical center. PATIENTS: The records of 379 consecutive adult patients who underwent tracheotomy by the Otolaryngology-Head and Neck Surgery Service from January 1992 to December 1996 were available for review and met inclusion criteria. All patients underwent postoperative chest radiography. MAIN OUTCOME MEASURES: Frequency of postoperative tracheotomy-associated complications, most significantly pneumothorax. RESULTS: The patients had no pneumothorax on postoperative chest films. Minor complications, which were found in 7.1% of the patients, included small bleeds, wound infection, and subcutaneous emphysema. Tracheostomy-associated death occurred in 2 patients (0.5%). CONCLUSIONS: Routine postoperative chest radiography is unnecessary after adult tracheotomy. Chest radiography may be indicated by clinically suspicious signs or symptoms.     

Practice patterns, safety, and rationale for tracheostomy tube changes: a survey of otolaryngology training programs

INTRODUCTION: Tracheotomy for long-term ventilation is a common surgical procedure in the hospital setting. Although the postoperative care is often perceived as routine, complications associated with tracheostomy changes may result in loss of airway and death. In addition, the practice patterns, rationale, and complications related to tube changes have been poorly described. STUDY DESIGN AND METHODS: A survey of chief residents in accredited otolaryngology training programs was performed to determine the management strategies, rationale, and complications associated with postoperative tracheostomy tube changes. RESULTS: The first tube change was performed after a mean of 5.3 (range, 3-7) days after the procedure, most frequently by junior residents. The first change was performed in a variety of locations including the intensive care unit (88%), step down unit (80%), and regular floor (78%). Twenty-five percent performed these changes at night or on weekends. The most frequently reported rationale for performing routine tracheotomy changes was examination of the stoma for maturity (46%), prevention of stomal infection (46%), and confirmation of stability for transport to a less monitored setting (41%). Twenty-five (42%) respondents reported awareness of a loss of airway, and nine (15%) respondents reported awareness of a death as a result of the first tube change at their institution during their residency. A statistically significant higher incidence of airway loss was reported by respondents who reported performing the first tube change on the floor (96.1% vs. 63.6%). CONCLUSION: There is significant variability in the approach to postoperative tracheostomy tube management. The occurrence of major complications including deaths from routine tube changes requires an examination of the rationale and safety of this practice.     

颈椎骨折病人的床边气管切开术

目的探讨颈椎骨折病人气管切开的操作要点和时机。方法总结24例颈椎骨折病人行气管切开的病例资料。结果24例病人无1例出现脊髓损伤加重和其他严重的手术并发症,术后1个月拔管率83.3%。结论颈椎骨折行气管切开的病人通过术前准确的评估和术中仔细操作,可以有效预防手术并发症的发生,有手术适应证的病人应行气管切开术。     

神经外科患者经皮气管切开术与传统气管切开术两种术式并发症的对比分析

目的观察经皮气管切开术与传统气管切开术术后并发症的异同并分析原因。方法采用前瞻性研究，将200例神经外科需要行气管切开术患者随机分为经皮气管切开术组和传统气管切开术组，每组各100例。统计两组两周内术后并发症数据。结果术后两周经皮气管切开术术后出血15例，皮下积气2例，切口感染2例，并发症总计19例；传统气管切开术出血4例，皮下积气3例，切口感染1例，并发症总计8例。两组术式术后出血发生率经比较具有统计学意义（P<0.05），两组术式术后皮下积气及切开感染发生率经比较均无统计学意义（P均>0.05），两组术式术后并发症总发生率存在明显差异，经比较具有统计学意义（P<0.05）。结论神经外科患者行经皮气管切开术早期术后并发症风险高于传统气管切开术。病情危重需要紧急开放气道的患者优先选用经皮气管切开术，肥胖颈短、病情相对平缓，无需立即开放气道的患者优先选用传统气管切开术。     

Extensive lymphangioma presenting with upper airway obstruction

OBJECTIVE: To describe the results of an outcome survey of 18 cases of pediatric lymphangioma with dyspnea from encroachment on the tongue base, parapharyngeal space, and/or larynx. DESIGN: Retrospective review of files from January 1983 to September 1998. SETTING: Pediatric otolaryngology departments from 2 referral centers. PATIENTS: Eighteen patients were treated. The average age at initial surgery was 22 weeks (median, 5 weeks). All presented with at least unilateral suprahyoid and infrahyoid cavernous (microcystic) lymphangioma. The tongue base was involved in 11 patients, the parapharyngeal space in 12, and the larynx in 8. INTERVENTIONS: Neck dissection was performed initially in all patients. Tracheotomy was performed in 9 patients (50%). Macroglossia was treated by V glossoplasty. Parapharyngeal extensions were treated by cervicotomy or endoscopy, and larynx and tongue base extensions by carbon dioxide laser photocoagulation. Supraglottic laryngectomy was performed in 2 patients. MAIN OUTCOME MEASURES: Residual disease, decannulation, duration of tracheotomy, and persistent respiratory symptoms. RESULTS: The average follow-up was 4 years postoperatively. One postoperative death occurred. Sixteen (94%) of the remaining 17 patients had residual lymphangioma. Eight (89%) of the 9 patients with tracheotomy underwent decannulation (average duration, 22 months). Ten patients had persistent symptoms, and 6 were asymptomatic. CONCLUSIONS: Involvement of the upper airway seems to be the determining prognostic factor in extensive lymphangioma. Patients with dyspnea by external compression of cervical lymphangioma on the airway responded well to surgery. Aggressive surgical treatment did not seem to significantly improve the prognosis in patients with intrinsic involvement of the upper airway. The natural evolution of untreated massive lymphangioma has not been documented. Less aggressive, symptomatic therapy may be an alternative to avoid mutilating surgery in patients with intrinsic involvement of the airway.     

Pediatric tracheotomy: is postoperative chest X-ray necessary?

A retrospective study of 101 children who underwent tracheotomy at the Children's Hospital of Pittsburgh from 1993 to 1996 was performed. The following criteria were reviewed in each patient: age, gender, race, prematurity, weight during tracheotomy, presence of preoperative airway support, duration of tracheotomy, nature (emergent versus elective), tracheotomy tube size, reason for tracheotomy, accompanying medical diagnoses, chest x-ray (CXR) findings, surgical service, postoperative symptoms (up to 3 days), and operative mortality rate. Of these criteria, our results show that CXR-screenable complications occurred in patients who underwent emergent recannulation, as well as those who exhibited ventilatory distress (oxygen saturation level of <90%) and specific changes in postoperative symptoms. Pneumothorax developed after tracheotomy in 3 of the 101 patients; each had one of these risk factors. We conclude that CXR of all pediatric patients after tracheotomy may be unnecessary with the use of flexible endoscopy and screening restrictions that are both health-conscious and cost-effective.     

Outcome in pediatric tracheotomy

OBJECTIVE: To investigate the outcome and related factors in pediatric tracheotomy. DESIGN: Retrospective chart review. SETTING: Tertiary pediatric academic hospital setting. PATIENTS: The study included 181 children below the age of 18 years who underwent 185 tracheotomies between 1991 and 1995. MAIN OUTCOMES AND MEASURES: Presenting symptoms and signs, indications, duration of follow-up, therapeutic and interval procedures, early and late complications, mortality, time to and success in decannulation. RESULTS: There were 108 (59.7%) male patients and 73 (40.3%) female patients. The average age of the children at the time of tracheotomy was 3.8 +/- 5.3 years. The majority of the children were less than 1 year of age (n = 99, 54.7%). Airway obstruction was the leading indication for tracheotomy (59.6%), followed by ventilatory support (30.4%) and pulmonary toilet (9.9%). The average duration of follow-up was 931 +/- 790 days. There were no perioperative complications. Early postoperative complications were seen in 28 (15.5%) children including 12 (6.8%) major complications and 22 (12.2%) minor complications. Late complications were seen in 115 (63.5%) children, including 8 (4.4%) major complications and 107 (59.1%) minor complications. Overall mortality rate was 13.3%, but only 1 tracheotomy-related death was caused by tube displacement. Therapeutic procedures were performed in 43% of the children, including laryngotracheal reconstruction (13%), laser excision of the lesion (5%), and supraglottoplasty (3.9%). Decannulation was accomplished in 116 (64.1%) of the children with an average of 365 +/- 388 days with tracheotomy. CONCLUSION: Tracheotomy is relatively safe in the pediatric population. Decannulation may be possible relatively quickly with resolution of the underlying problem.     

阻塞性睡眠呼吸暂停低通气综合征患者气管切开术

目的探讨气管切开术作为一种治疗方法在阻塞性睡眠呼吸暂停低通气综合征患者气管切开术(obstructive sleep apnea hypopnea syndrome,OSAHS)治疗中的应用。方法OSAHS患者行气管切开术4例。预防性的气管切开2例,1例为悬雍垂腭咽成形术(uvulopalatophar yngoplasty,UPPP)和颏舌肌前移舌骨悬吊术治疗(GAHM)术后的预防性气管切开,1例为UPPP术前的预防性气管切开,2例为永久性气管切开手术。预防性的气管切开采用常规气管切开方法,永久性气管切开采用Fee和Warld的永久性气管切开术,并对相关文献进行了复习。结果预防性的气管切开能降低重度OSAHS患者UPPP、GAHM等手术的术后风险,永久性气管切开术对极重度OSAHS患者是一种挽救性手术。结论气管切开术作为一种有效的治疗OSAHS的方法,对于一些极重度阻塞性睡眠呼吸暂停低通气综合征患者有不可替代的作用。