以直接縫合來關閉持續性的氣管皮瘻管

Primary Closure of Persistent Tracheocutaneous fistula

李學禹(Hsueh-Yu Li)

《中華民國耳鼻喉科醫學會雜誌》 33卷5期 (1998/10) Pp. 480-485

https://doi.org/10.6286/1998.33.5.480

摘要

背景：氣管皮瘻管是長期氣切或T型管置入術後常見的後遺症。持續性的氣管皮瘻管
除了頸部的缺陷外，也帶給病患社交的呆窘及吞嚥與發聲的障礙，且可因瘻管不慎入水而導致肺炎等嚴重合併症。因此以手術來關閉持續性的氣管皮瘻管
實屬的必要。
方法：本文回顧1996年6月至1998年2月間，18例因抹續性氣管皮瘻管而至本院接直接縫合手術之病例。手術進行前病患先作支氣管鏡檢查，以確定上呼吸道沒有阻塞性病變，而後再插管全身麻醉。手術步驟主要包括瘻管皮瓣的分離、修剪與接連續縫合。
結果：病患年齡平均31歲，從單純氣切或T型管置入術到拔管為4至24月，平均個11月。而從拔管到接直接縫合手術的時間為2至20個月，平均7.1個月。經直接縫合手術後，有1名成人病患出現喘鳴，經醫急氣切後重新置放T型管。另1例小孩之傷口有感染現象，經保治療後癒合。其餘病患之傷口則癒合良好無合併症。
結論：對於持續性氣管皮瘻管，作者主張施以手術治療。本文採用的直接連續縫合法有步驟簡單、快速癒合及傷口美觀等優點，為一安全且有效的治療方法。但在術前須以支氣管鏡評估氣道，並於術後嚴密監視病患之呼吸狀態，如此方能避免合併症的發生。

關鍵字

氣管皮瘻管 ； 直接縫合

並列摘要

Background: Tracheocutaneous fistula is a common sequela of long term tracheostomy and T-tube insertion. Thepresence of persistent tracheocutaneous fistula is more than a cosmetic problem to the patient, excessive secretion expelled from trachea can present a hygienic problem and embrarrass social situation. Aspiration may occur and result in pneumonia. Dyspehagia and phonatory problem are also noted. Therefore, surgical treatment is mandatory.
Methods: Our series consisted of a retrospective review of primary closure of patients with persistent tracheocutaneous fistula at Chang gung memorial hospital between January 1997 and February 1998. All patients received bronchoscopy before surgery to exclude any airway obstrustion. Operation was performed under general anesthesia, and the steps included dissection, trimming and suture of tacheocutanous fistula.
Result: Then mean patient age was 31, and the mean diucation between decannulation and fistula closure was 7.1 months. One adult patient developed stridor after surgery, emergent tracheostomy was done and T-tube was rinserted. One pediatric patient developed infection and mild disruption of wound. Broad antibiotics were given and wound was completely healed. The postoperative course of other patients was smooth and the surgical wounds were in good cosmetic result.
Conclusions: Surgical closure of persistent tracheocutaneous fistula is mandatory to decrease morbidity and increase life quality of patients. The advantages of primary closure include simple step, fast healing and good cosmetic result. This method is suggested to patients with careful preoperative evaluation and postoperative observation of airway to prevent complication.

並列關鍵字

tracheocutaneous fistula ； primary closure