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氣管切開術 92例에 對한 臨床的 考察

Clinical Studies on 92 Cases of Tracheotomy

중앙의학 1964년 7권 3호 p.329 ~ 344
朴海壽, 강동숙,
소속 상세정보
朴海壽 (  ) - 가톨릭大學 醫學部 耳鼻咽喉科學校室
강동숙 (  ) - 가톨릭大學 醫學部 耳鼻咽喉科學校室

Abstract


Airway obstruction is one of the few real emergencies in medical practice. The history of tracheotomy is long and still it remains as one of the most important life saving procedure in case of asphyxia. This article report the result of clinical studies on 92 cases of tracheotomy performed at the E. N. T. Clinic, Inchon Methodist hospital, Inchon, Korea, covering-a three years period from January, 1960 to December, 1962.
Among 719 E. N. T. operations, tracheotomy cases were 92 (12.6 per cent). This was surprisingly high number in frequency, 58 (63 per cent) of these cases were male and 34 (37 per cent) were female.
Approximately two third of the cases were between one and five years of age (58.6 per cent), and youngest was 13 months and oldest was 58 year-old.
Majority of the cases occurred in winter time while none case occurred in August and September.
Analysis of the causative disease revealed more than two third of the cases were laryngeal or pharyngeal diphtheria, and none diphtheric acute laryngitis, laryngeal abscess, laryngeal edema, retropharyngeal abscess, intoxication, foreign body, Ludwig´s angina, laryngeal cancer, laryngeal papilloma were next in order.
Decannulation could be performed within one week in the most of diphtheria cases.
The complication rate was 16.3 per cent (15 cases), and following postoperative complications were seen: cervical subcutaneous emphysema in four cases, mediastinal emphysema in one case, pneumothorax in one case, postoperative hemorrhage in two cases, pulmonary. atelectasis in three cases, and possible pneumonia in one case. As a permanent complication hoarseness developed in one case, caused by protracted perichondritis, which occurred following severe laryngeal abscess.
The mortality rate was 8.6 per cent: 8 cases were died during or after operation. Three caes who died during operation visited the hospital with almost exhausted state because of imminent asphyxia. Among five cases, who died after operation, one death occurred due to extensive mediastinal emphysema with pneumothorax, one due to reobstruction of the airway, two due to cardiac failure(diphtheria cases), and one due to unknown cause.
Following warnings summarized:
1) Tracheotomy should never be underestimated as a simple and easy surgical procedure, this is especially true in children and emrgency situation,
2) Unless temporary adequate airway is being provided general anesthesia. must be avoided even routine premedication such as administration of sedatives or narcotics.
3) Policy of watch and wait until last minutes should be condemned: tracheotomy should be done as elective rather than emergency.
4) In case of impending asphyxia emergency establishment of airway, such as introduction of bronchoscope, Mosher´s life saving tube, or endotracheal tube, is considered to be very wise way to perform uneventful tracheotomy, it is, however, almost impossible to do so in some occasions. In such instances emergency tracheotomy is mandatory.
5) Surgeon should familiar with both orderly tracheotomy and emergency tracheotomy technic.
6) As Jackson recommended authors emphasize that tracheotomy should be done as low as possible, this is particularly so in younger age group to pervent decannulation difficulty.
7) Aftercare cf tracheotomized case is not easy. Doctor and nurses should always keep in mind that reobstruction of the airway can be happened by various causes, Regulation of the room temperature and humidity seems to be very important in keeping airway free from crust formation.

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