| 摘要 |
Objectives: The use of percutaneous dilatational tracheostomy (PDT) has become
more prevalent over the past decade. While recent studies have advocated
intraoperative bronchoscopic guidance during the procedure, the routine use of
intraoperative bronchoscopy is still controversial. Herein, we present our experience
of percutaneous dilatational tracheostomy without bronchoscopic guidance.
Methods: From July 2004 through December 2008, 165 patients who underwent
PDT without bronchoscopic guidance were enrolled. The PDT technique was as
follows: (1) subcutaneous tissue was dissected down to the pretracheal fascia until
direct visualization of the anterior tracheal wall; (2) a mosquito clamp was used to
identify the correct puncture level of the trachea; (3) a fingertip was used to guide
the endotracheal (ET) tube, which was withdrawn to the level above the puncture
site; (4) the ET tube was pushed forward to prevent posterior tracheal wall injury
while introducing a Seldinger wire. All patients’ preoperative condition and
postoperative outcome were recorded for analysis.
Results: The mean operating time was 6.2±1.6 minutes. One patient (0.6%) died of
posterior tracheal wall injury with subsequent tracheal bleeding and tears.
Complication occurred in 31 cases (18.8%), including stoma infection in 22 cases
(13.3%), stoma oozing in 7 cases (4.2%) and tracheal tear in one case (0.6%).
Conclusions: We have demonstrated that with minimal dissection of the
pretracheal fascia, it is possible to perform precise counting of the tracheal rings and
advancement of the ET tube. Then, the routine use of bronchoscopic guidance for a
safe PDT may not be necessary. |
