小兒氣管皮瘻

Pediatric Tracheocutaneous Fistula

林嘉德(Chia-Der Lin) ； 譚慶鼎(Ching-Ting Tan) ； 張逸良(Yih-Leong Chang) ； 陳為銓(Jiann-Chyuan Chen) ； 李憲彥(Shiann-Yann Lee)

《中華民國耳鼻喉科醫學會雜誌》 33卷6期 (1998/12) Pp. 585-590

https://doi.org/10.6286/1998.33.6.585

摘要

背景:部份氣切患者在拔管後，氣切造口可能無法癒合而形成氣管皮瘻;這特別容易發生在長期管切開及嬰幼兒時期接受管切開的患者，對患者及家屬的生活造成不少困擾。本文主要回溯性討論近幾年來處理小兒氣管皮瘻患者的方法與經驗，並由取下瘻管之組織研究，討氣氣管皮瘻可能的形成機轉。
年:民國84年3月至民國87年3月間本科收集小兒氣管皮瘻病患共13例，分析患者接受氣管切開的原因、年齡及拔管時的年齡。手術採瘻管切除並多層縫合的方式。部份取下之氣管皮瘻作顯微組織研究。
結果:這些病患接受氣管開的平均年齡為29個月大;氣切造口平均維持時間為49個月;追蹤氣管皮瘻的平均時間為14個月。瘻管組織檢查發現皮下明顯纖維化並表面覆以扁平上皮，部份可發現扁平上皮與纖毛柱狀呼吸上皮連接在一起的現象。術後併發症 : 1例皮下及縱膈氣腫 ; 另1例發生感染。
結論:本報告中氣管皮瘻患者平均氣管造口維持時間超過4年，組織檢查顯示皮下明顯纖維化並表面覆以扁平上皮;因此氣管皮瘻是長期發炎造成疤痕纖維化及扁平上皮長入瘻管，使氣管造口無法癒合。手術閉合前應先以喉氣管鏡檢查，術後須密切觀察病人的呼吸狀態;可能的併發症包括傷口感染及皮下和縱膈氣腫。

關鍵字

氣管切開 ； 氣管皮瘻 ； 小兒的

並列摘要

Background: Long-term tracheostomized children may suffer from tracheocutaneous fistula after decannulation. Persistent tracheostoma increases morbidity in children with limited pulmonary reserve. Surgical closure is recommended for persistent tracheostoma. Operative management and its outcome are reviewed. The pathogenesis of tracheoucutaneous fistula is also discussed.
Mothed: Thirteen children with tracheocuaneous fistula were analyzed with respect to primary diagnosis, age at the time of the tracheotomy and duration of tracheotomy. Some of the excised fistulae after surgical closure were sent for histopatholologic examination.
Results: In the recent 3 years, we retrospectively followed 13 consecutive children with presisited tracheocutaneous fistula. The mean duration of tracheotomy was over 4 years. Approximately 69% of the tracheoltomies were performed in patients less than 12 months of age. Using surgical closure technique, 11 fistulae were successfully closed (average follow-up, 14 months). Histopathologic examination of these fistulae revealed marked subepithelial fibrosis with transition zone of squamous epithelium to ciliated columnar epithelium over the fistula tract. Two patients experienced major complications: one with marked subcutaneous emphysema and pneumomedisatinum and the other with local wound infection.
Conclusion: Histopathologic examination reveals that it is the ingrowth of squmaous epithelium and cicatricial resolution of chronic inflammation over time that result in the persistence of tracheostoma. Laryngobronchoscopic examination prior to surgical closure is necessary. Post-operative complications include air leakage and infection.

並列關鍵字

tracheotomy ； tracheocutaneous fistula ； pediatric