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頁籤選單縮合
題名 | 氣管切開術在口腔顎面外科應用之臨床分析=Clinical Analysis of Tracheostomy in Oral and Maxillofacial Surgery |
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作者 | 李正喆; 郭生興; 章浩宏; 林長春; 楊博正; 韓良俊; 郭英雄; | 書刊名 | 中華牙醫學雜誌 |
卷期 | 20:1 2001.03[民90.03] |
頁次 | 頁29-36 |
分類號 | 416.95 |
關鍵詞 | 氣管切開術; 適應症; 併發症; 口腔顎面外科; Tracheostomy; Indication; Complications; Oral and maxillofacial surgery; |
語文 | 中文(Chinese) |
中文摘要 | 本文報告臺大醫院口腔顎面外科過去六年間施行氣管切開術75例的經驗。患者年 齡介於 19 至 78 歲,平均 50.6 歲;男性 64 名( 85.3 %),女性 11 名( 14.7 %) 。 手術的適應症以常規性頭頸外科手術最多( 84 %), 其次為上呼吸道阻塞及病變( 13.3 %)。 疾病診斷以口腔癌( 57.3 %)佔大多數,其次為鼻咽癌放射線照射後顎骨壞 死( 22.7 %)病例。 與氣切手術相關之早期併發症包括出血( 4.0 %)、 皮下氣腫( 4.0 %)、套管移位( 2.7 %),晚期併發症包括胸部感染( 2.7 %)、拔管困難( 1.3 %),無呼吸中止或與氣切相關之術後死亡病例,手術併發症發生率為 14.7 %。引起併發 症產生的危險因素包括二度氣切、在局部麻醉、非手術室及緊急情況下施行氣切手術等;但 在充分準備的情況下,氣管切開術可被証明為一相當安全、簡單又實用的手術。從研究結果 發現,隨著口腔癌病例數目的逐年增加,在口腔顎面外科接受氣管切開術的患者有越來越多 的趨勢,因此建議每一位口腔顎面外科醫師皆應該熟悉此手術的適應症、操作技巧及併發症 的處置。 |
英文摘要 | Clinical experiences with 75 tracheostomies performed in the Department of Oral and Maxillofacial Surgery, National Taiwan University Hospital over the past six years are described. The ages of the patients ranged between 19 and 78 with an average age of 50.6 years. Of the the patients, 64 (85.3%) were male and 11 (14.7%) were female. The most common indication for tracheostomy was routine head and neck surgery (84%), and obstruction or lesions of the upper airway (13.3%) came next. Oral cancer (57.3%) was the primary diagnosis in most of the patients, followed by osteora-dionecrosis of the jaws following radiotherapy for nasopharyngeal carcinoma (22.7%). Early complications related to tracheostomy included bleeding (4.0%), subcutaneous emphysema (4.0%) and dislodgment of the cannula (2.7%). Chest infection (2.7%) and extubation difficulities (1.3%) were the most frequently encountered late complications. Respiratory arrest or death related to tracheostomy did not occur in the series. The over-all complication rate was 14.7%. Tracheostomy revisions, and operations performed under local anesthesia, outside of theater or in emergency situations were all risk factors that increased the risk of complications. Nevertheless, in a well-prepared environment, tracheostomy is a safe, simple, and useful surgical procedure. From the analysis it can be seen that, with the increasing incidence of oral cancer in Taiwan, oral and maxillofacial surgery departments will need to perform more and more tracheostomies. Consequently, every oral and maxillofacial surgeon should be familiar with the indications, surgical techniques and management of the complications of tracheostomy. |
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