经皮气管切开术在后颅窝肿瘤术后患者中的临床价值
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摘要
目的评价经皮气管切开在后颅窝肿瘤术后患者中的临床价值。方法回顾性分析86例后颅窝肿瘤术后气管切开的患者临床资料,其中经皮气管切开44例(A组),传统气管切开42例(B组),观察手术时间、出血量、切口愈合时间、并发症,并进行统计学分析。结果 A组平均手术时间(6.31±1.14)min,平均出血量(9.34±2.09)m L,平均切口愈合时间(2.60±0.28)d,平均切口瘢痕大小(0.50±0.11)cm~2,术中无大出血、皮下气肿及切口感染,切口渗血2例,呃逆1例,持续咳嗽1例;B组平均手术时间(32.51±4.34)min,平均出血量(19.76±3.25)mL,平均切口愈合时间(7.60±1.80)d,平均切口瘢痕大小(1.00±0.27)cm~2,术中1例出现大出血,术后切口渗血10例,皮下气肿8例,切口感染5例,持续咳嗽2例。经统计学分析,两组患者在手术时间、出血量、切口愈合时间、切口瘢痕大小、并发症发生率等方面的差异有统计学意义(P<0.05)。结论后颅窝肿瘤术后需行气管切开的患者,经皮气管切开操作简单、创伤小、出血少、切口愈合快,且并发症发生率低,可作为首选术式进行临床推广应用。
Objective To evaluate the clinical value of transcutaneous gastrectomy in patients with posterior fossa tumors. Methods The clinical data of 86 patients with posterior fossa tumors after gastrectomy were retrospectively analyzed. Among them, 44 patients underwent percutaneous gastrectomy(group A) and 42 patients underwent conventional gastrectomy(group B). The operation time, blood loss, wound healing time and complications were observed and statistically analyzed. Results The average operation time of group A was(6.31±1.14) min, the average blood loss was(9.34±2.09)mL, the average incision healing time was(2.60±0.28) days, and the average incision scar size was(0.50±0.11)cm~2.And there was no major bleeding, subcutaneous emphysema and wound infection during operation. There were 2 cases of incision oozing, 1 case of hiccup, and 1 case of persistent cough. The average operation time of group B was(32.51±4.34)min, the mean blood loss was(19.76±3.25) mL, the average incision healing time was(7.60±1.80) days, and the average incision scar size was(1.00±0.27)cm~2. There was 1 case of major bleeding during operation, 10 cases of incision oozing, 8 cases of subcutaneous emphysema, 5 cases of wound infection, and 2 cases of persistent cough. After statistical analysis, the operation time, blood loss, wound healing time, incision scar size, and complication rate between the two groups, the differeces were statistically significant(P<0.05). Conclusion Percutaneous tracheotomy in patients undergoing tracheotomy after posterior fossa tumors has simple operation, less trauma, less bleeding, faster incision healing, and low complication rate, which can be used as the first choice for clinical application.
Objective To evaluate the clinical value of transcutaneous gastrectomy in patients with posterior fossa tumors. Methods The clinical data of 86 patients with posterior fossa tumors after gastrectomy were retrospectively analyzed. Among them, 44 patients underwent percutaneous gastrectomy(group A) and 42 patients underwent conventional gastrectomy(group B). The operation time, blood loss, wound healing time and complications were observed and statistically analyzed. Results The average operation time of group A was(6.31±1.14) min, the average blood loss was(9.34±2.09)mL, the average incision healing time was(2.60±0.28) days, and the average incision scar size was(0.50±0.11)cm~2.And there was no major bleeding, subcutaneous emphysema and wound infection during operation. There were 2 cases of incision oozing, 1 case of hiccup, and 1 case of persistent cough. The average operation time of group B was(32.51±4.34)min, the mean blood loss was(19.76±3.25) mL, the average incision healing time was(7.60±1.80) days, and the average incision scar size was(1.00±0.27)cm~2. There was 1 case of major bleeding during operation, 10 cases of incision oozing, 8 cases of subcutaneous emphysema, 5 cases of wound infection, and 2 cases of persistent cough. After statistical analysis, the operation time, blood loss, wound healing time, incision scar size, and complication rate between the two groups, the differeces were statistically significant(P<0.05). Conclusion Percutaneous tracheotomy in patients undergoing tracheotomy after posterior fossa tumors has simple operation, less trauma, less bleeding, faster incision healing, and low complication rate, which can be used as the first choice for clinical application.
引文
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[7] Khan AZ,Khan A, Naseem A.Percutaneous tracheostomy by physician intensivists[J]. J Coll Physicians Surg Pak,2018,28(3):222-225.
[8] Guttormson JL,Bremer KL,Jones RM.“Not being able to talk was horrid”:A descriptive, correlational study of communication during mechanical ventilation[J]. Intensive Care Med,2015,31:179-186.
[9] Rashid AO,Islam S. Percutaneous tracheostomy:A comprehensive review[J]. J Thorac Dis,2017,9(Suppl 10):S1128-S1138.
[10] Matsumura S,Kishimoto N,Iseki T,et al. Tension pneumothorax after percutaneous tracheostomy[J]. Anesth Prog.Summer,2017,64(2):85-87.
[11] Freeman-Saderson AL,Togher L,Elkins MR,et al. Return of voice for ventilated tracheostomy patients in ICU:A randomized controlled trial of early-targeted intervention[J]. Crit Care Med,2016,44:1075-1081.
[12] Smith D,Loschner A,Rubio E. Routine use of bronchoscopy in percutaneous tracheostomy[J]. J Crit Care,2017,41:331.
[13] Terragni P,Brazzi L,Ranieri VM. New training on percutaneous tracheostomy[J]. Minerva Anestesiol. 2017,83(4):423.
[14]胡均贤,赵德英,袁玉明,等.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[J].中国耳鼻咽喉颅底外科杂志,2018,24(3):284-287.
[15]唐建周,罗晖,韦明豪.经皮扩张气管切开术在危重患者中的应用效果观察[J].广西医科大学学报,2017,(3):405-409.
[2] Kidane B, Pierre AF. From open to bedside percutaneous tracheostomy[J]. Thorac Surg Clin,2018,28(3):263-276.
[3] Asakura Y. Thoraco-esophageal fistula during percutaneous tracheostomy[J]. J Anesth,2018,32(4):653.
[4] Lim CK,Ruan SY,Lin FC,et al. Effect of tracheostomy on weaning parameters in difficult-to-wean mechanically ventilated patients:A prospective observational study[J].PLoS One,2015,10:e0138294
[5] Rees J,Haroon Y,Hogan C,et al. The ultrasound neck imaging for tracheostomy study:A study prompting ultrasound screening prior to percutaneous tracheostomy procedures to improve patient outcomes[J]. J Intensive Care Soc,2018,19(2):107-113.
[6] Sutt AL,Cornwell P,Mullany D,e t al.The use of tracheostomy speaking valves in mechanically ventilated patients results in improved communication and does not prolong ventilation time in cardiothoracic intensive care unit patients[J]. J Crit Care,2015,30:491-494.
[7] Khan AZ,Khan A, Naseem A.Percutaneous tracheostomy by physician intensivists[J]. J Coll Physicians Surg Pak,2018,28(3):222-225.
[8] Guttormson JL,Bremer KL,Jones RM.“Not being able to talk was horrid”:A descriptive, correlational study of communication during mechanical ventilation[J]. Intensive Care Med,2015,31:179-186.
[9] Rashid AO,Islam S. Percutaneous tracheostomy:A comprehensive review[J]. J Thorac Dis,2017,9(Suppl 10):S1128-S1138.
[10] Matsumura S,Kishimoto N,Iseki T,et al. Tension pneumothorax after percutaneous tracheostomy[J]. Anesth Prog.Summer,2017,64(2):85-87.
[11] Freeman-Saderson AL,Togher L,Elkins MR,et al. Return of voice for ventilated tracheostomy patients in ICU:A randomized controlled trial of early-targeted intervention[J]. Crit Care Med,2016,44:1075-1081.
[12] Smith D,Loschner A,Rubio E. Routine use of bronchoscopy in percutaneous tracheostomy[J]. J Crit Care,2017,41:331.
[13] Terragni P,Brazzi L,Ranieri VM. New training on percutaneous tracheostomy[J]. Minerva Anestesiol. 2017,83(4):423.
[14]胡均贤,赵德英,袁玉明,等.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[J].中国耳鼻咽喉颅底外科杂志,2018,24(3):284-287.
[15]唐建周,罗晖,韦明豪.经皮扩张气管切开术在危重患者中的应用效果观察[J].广西医科大学学报,2017,(3):405-409.