頁籤選單縮合
題名 | 小兒氣管皮瘻=Pediatric Tracheocutaneous Fistula |
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作者 | 林嘉德; 譚慶鼎; 張逸良; 陳建銓; 李憲彥; | 書刊名 | 中華民國耳鼻喉科醫學會雜誌 |
卷期 | 33:6 1998.12[民87.12] |
頁次 | 頁25-30 |
分類號 | 416.899 |
關鍵詞 | 氣管切開; 氣管皮瘻; 小兒的; Tracheotomy; Tracheocutaneous fistula; Pediatric; |
語文 | 中文(Chinese) |
中文摘要 | 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□;這特別 容易發生在長期氣管切開及嬰幼兒時期接受氣管切開的患者,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□患者的方法與經驗,並由取下□管之 組織的研究,探討氣管皮□可能的形成機轉。 方法:民國84年3月到民國87年3月間本科收集小兒氣管皮□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□管切除並多層縫合的方式。部份取 下之氣管皮□作顯微組織的研究。 結果:這些病患接受氣管切開的平均年齡為29個月大;氣切造口平均維持時間為49個 月;追蹤氣管皮□的平均時間為14個月。□管組織檢查發現皮下明顯纖維化並表面覆以扁 平上皮,部份可以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□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□是長期發炎造成疤痕纖維化及扁平上皮長入□ 管,使氣管造口無法癒合。手術閉合前先以喉氣管鏡檢查,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。 |
英文摘要 | 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 outcom are reviewed. The pathogenesis of tracheocutaneous fistula is also discussed. Method: 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 histopathologic examination. Results: In the recent 3 years, we retrospectively followed 13 consecutive children with persisted tracheocutaneous fistula. The mean duration of tracheotomy was over 4 years. Approximately 69% of the tracheotomies 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 mrked subcutaneous emphysema and pneumomediastinum 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. |
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