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題名 | 在遠距鏡影像監視下摘除氣切上方肉芽腫=Removal of Suprastomal Granuloma Under the Guidance of Video-Telescopy |
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作者 | 李學禹; 鄭嘉遜; Li, Hsueh-yu; Chen, Ka-shun; |
期刊 | 中華民國耳鼻喉科醫學雜誌 |
出版日期 | 19990900、19991000 |
卷期 | 34:5 民88.09-10 |
頁次 | 頁368-372 |
分類號 | 416.899 |
語文 | chi |
關鍵詞 | 氣切上方肉芽腫; 遠距鏡; 氣管切開; Suprastomal granuloma; Telescope; Tracheostomy; |
中文摘要 | 目的:氣切上方肉芽腫是長期留置氣切管的後遺症,它可阻塞氣道,使氣切管無 法拔除,病患因此無法恢復正常呼吸。有關氣切上方肉芽腫的摘除方法,在以往了從內視 鏡或氣切口著手,兩者各有其優點,但若面臨手術視野不佳時,肉芽腫常無法徹底清除, 因此本文針對此問題,提出另一種手術方法。 方法:本文收集1997年6月至1998年6月間,20例因氣切上方肉芽腫而接受此種新的手術方 法之病例。手術採靜脈麻醉併高頻率噴氣式換氣,助手以支氣管鏡暴露出肉芽腫,並結合 遠距鏡與影像系統,使肉芽腫能明顯的呈現在電視螢幕上,而手術者應用鼻竇手術之器械 自氣切口將肉芽腫切除。 結果:在遠距鏡影像監視下,肉芽腫皆能順利摘除,手術過程中並未出現明顯出血。手術 的時間從25分至60分(平均43.3分)。20例中有14例順利拔除氣切管,其餘6例中有4例因肺 功能不佳仍需呼吸器,因而無法拔管,另2例則在拔管失敗後再置回氣切管。整個治療中 並未出現任何合併症。 結論:此種手術方法,能提供穩定的麻醉換氣,讓手術者於電視螢幕的監視下,精確且徹 底的清除肉芽腫,為氣切上方肉芽腫的處理提供另一有效的治療方式。 |
英文摘要 | Background: Suprastomal granuloma is a common sequela of long term tracheostomy. It can obstruct the airway and result in failure of decannulation. The traditional method to remove a suprastomal granuloma is done through a transoral endoscopic or trans-stomal approach. However, these two approaches may have the disadvantage of limited visualization during surgery. We have developed a new technique to remove a suprastomal granuloma through the tracheostoma under the guidance of a transoral videotelescope. Materials and Methods: Twenty consecutive patients who were treated in Chang Gung Memorial Hospital from June 1997 to June 1998 were studied retrospectively. All of the operations were performed under intravenous anesthesia with high-frequency jet ventilation. A bronchoscope, coupled with a telescope and video system, was inserted by an assistant to expose the granuloma. The operator used a sinoscopic instrument to remove the granuloma via a stomal approach under TV monitor guidance. Results: The granuloma was removed smoothly, without obvious bleeding during the operation. The mean operation time was 43.3 minutes. Fourteen out of 20 patinets were successfully decannulated. The others remained on a tracheostomy tube due to poor pulmonary function. There were no complications in the whole course. Conclusion: This new technique can provide stable anesthesia and an excellent operative field under telescopic video guidance. We believe that it is safe and effective. in the treatment of suprastomal granuloma. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。