后颅窝肿瘤术后儿童气管切开原因及预后转归分析

doi:10.6040/j.issn.1673-3770.0.2025.028

摘要/Abstract

摘要： 目的探讨后颅窝肿瘤术后气管切开儿童的病例特点、气管切开原因及预后转归情况。方法回顾性分析因后颅窝肿瘤行气管切开术的患儿26例,记录并分析患儿的基本信息、后颅窝肿瘤相关情况、术后气管插管时间、术后呼吸及吞咽情况、行气管切开的主要病因、气管切开并发症、是否拔管及气切管带管时间等。对所有患儿进行门诊及电话随访。结果 26例患儿中男19例、女7例,平均(4.60±3.08)岁。肿瘤位于第四脑室/小脑蚓部15例,延髓、脑干7例,桥脑2例,颈静脉孔区1例,小脑半球1例。术后病理星形细胞瘤6例,室管膜瘤8例,脑膜瘤1例,颅咽管瘤1例,脂肪瘤1例,髓母细胞瘤9例。术后因长期带管,不能停止机械通气行气管切开的患儿25例,术后平均麻醉插管时间14 d。已经拔除气管插管,因呼吸困难于术后1个月行气管切开的患儿1例。随访时间1~5年。2例患儿失访,2例患儿死亡,气管套管未拔除患儿9例,已拔管患儿13例,已拔管患儿平均带管时间7.8个月。术后鼻饲饮食患儿13例。左侧声带麻痹2例,右侧声带麻痹2例,双侧声带麻痹4例。所有患儿气管切开围手术期及术后2周内未发生伤口出血、脱管、气切管堵塞等手术并发症,气切拔管后无气管狭窄、气管软化等并发症出现。结论后颅窝肿瘤术后后组颅神经功能障碍患儿行气管切开术安全有效。后颅窝肿瘤术后气管切开患儿需定期评估呼吸、吞咽恢复情况,并根据患儿个体情况决定拔管时机。

关键词: 气管切开术, 后颅窝肿瘤, 儿童, 后组颅神经功能障碍

Abstract: Objective This study aims to explore the clinical characteristics and outcomes of children who underwent tracheostomy after posterior cranial fossa tumor resection. Methods A retrospective analysis was conducted on 26 pediatric cases that underwent tracheostomy due to posterior fossa tumors. The following data were collected and analyzed: basic patient information, postoperative intubation duration, postoperative respiratory and swallowing conditions, tracheotomy indications, tracheotomy complications, and tracheotomy duration. Patients were observed for at least one year, with follow-ups conducted in outpatient settings or via telephone. Results This study included a total of 26 patients, consisting of 19 males and 7 females. The patients’ ages of the patients ranged from 1 to 13 years old, with an average age of(4.60±3.08)years. The tumor locations were as follows: the fourth ventricle/vermis of the cerebellum in 15 cases, the medulla oblongata and brainstem in 7 cases, the pons in 2 cases, the jugular foramen area in 1 case, and the cerebellar hemisphere in 1 case. Postoperative pathology results were as follows: astrocytoma in 6 cases, ependymoma in 8 cases, meningioma 1 case, craniopharyngioma 1 case, lipoma 1 case, and medulloblastoma in 9 cases. The tracheotomy operation was performed in 25 children for the purpose of persistent mechanical ventilation. The average duration of anesthetic intubation was 14 days. One child was extubated post-surgically but subsequently underwent tracheotomy one month after the operation due to breathing difficulties. Of the 26 patients, two were lost to follow-up, two died, thirteen underwent decannulation, and nine did not. The mean duration of tracheotomy tube usage was 7.8 months. Thirteen children received nasal feeding due to swallowing problems. There were two cases of left vocal cord paralysis, two cases of right vocal cord paralysis, and four cases of bilateral vocal cord paralysis. No patient experienced complications within a period of two weeks following their tracheotomy surgery. Following-decannulation, there were no complications related to tracheal stenosis or tracheomalacia. Conclusion The safety and efficacy of tracheotomy in children diagnosed with posterior cranial nerve dysfunction following surgical intervention for posterior cranial fossa tumors has been well-documented. Children who undergo tracheotomy after posterior cranial fossa tumor surgery require regular evaluation for respiratory and swallowing recovery. The timing of decannulation should be determined based on the individual situation of the child.

Key words: Tracheotomy, Posterior cranial fossa tumor, Children, Posterior cranial nerves dysfunction

中图分类号:

R739.41

王华,张丰珍,龙婷,赵靖,李宏彬,王生才,王桂香. 后颅窝肿瘤术后儿童气管切开原因及预后转归分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 168-173.

WANG Hua, ZHANG Fengzhen, LONG Ting, ZHAO Jing, LI Hongbin, WANG Shengcai, WANG Guixiang. Analysis of the reasons and prognostic outcomes for tracheostomy in pediatric patients following posterior fossa tumor resection[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(4): 168-173.

参考文献 20

[1]	Resen MS, Grønhøj C, Hjuler T. National changes in pediatric tracheotomy epidemiology during 36 years[J]. Eur Arch Otorhinolaryngol, 2018, 275(3): 803-808. doi:10.1007/s00405-018-4872-0
[2]	Lele SJ, Stephen S, Raman EV. Changing indications for pediatric tracheotomy: an urban Indian study[J]. Indian J Otolaryngol Head Neck Surg, 2019, 71(suppl 1): 501-505. doi:10.1007/s12070-018-1373-9
[3]	Tomita T, Grahovac G. Cerebellopontine angle tumors in infants and children[J]. Childs Nerv Syst, 2015, 31(10): 1739-1750. doi:10.1007/s00381-015-2747-x
[4]	王桂香, 张丰珍, 王华, 等. 儿童不同病因气管切开术并发症及转归分析[J]. 中华耳鼻咽喉头颈外科杂志, 2021, 56(4): 356-362. doi:10.3760/cma.j.cn115330-20200515-00418.
[5]	陈雪霞, 李小金, 刘建明, 等. 呼吸机相关肺炎患者病原学特点及影响因素分析[J]. 中华医院感染学杂志, 2017, 27(21): 4861-4864. doi:10.11816/cn.ni.2017-171096 CHEN Xuexia, LI Xiaojin, LIU Jianming, et al. Etiological characteristics of patients with ventilator-associated pneumonia and influencing factors[J]. Chinese Journal of Nosocomiology, 2017, 27(21): 4861-4864. doi:10.11816/cn.ni.2017-171096
[6]	Salley JR, Kou YF, Shah GB, et al. Comparing long-term outcomes in tracheostomy placed in the first year of life[J]. Laryngoscope, 2021, 131(9): 2115-2120. doi:10.1002/lary.29440
[7]	Luu K, Belsky MA, Dharmarajan H, et al. Dysphagia in pediatric patients with tracheostomy[J]. Ann Otol Rhinol Laryngol, 2022, 131(5): 457-462. doi:10.1177/00034894211025179
[8]	Shay S, Shapiro NL, Bhattacharyya N. Revisits after pediatric tracheotomy: airway concerns result in returns[J]. Int J Pediatr Otorhinolaryngol, 2018, 104: 5-9. doi:10.1016/j.ijporl.2017.10.021
[9]	Duymaz YK, ?瘙塁ahin ?瘙塁, Erkmen B, et al. Evaluating YouTube as a source of patient information for pediatric tracheostomy care[J]. Int J Pediatr Otorhinolaryngol, 2023, 171: 111580. doi:10.1016/j.ijporl.2023.111580
[10]	吴柳青, 梁正中, 唐向荣. 小儿气管切开术并发症原因分析[J]. 山东大学耳鼻喉眼学报, 2007, 21(2): 163-165. doi:10.3969/j.issn.1673-3770.2007.02.025 WU Liuqing, LIANG Zhengzhong, TANG Xiangrong. Complications of tracheotomy in children[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2007, 21(2): 163-165. doi:10.3969/j.issn.1673-3770.2007.02.025
[11]	Madgar O, Kassif Lerner R, Devons-Sberro S, et al. The safety of pediatric bedside tracheostomy[J]. Ann Otol Rhinol Laryngol, 2024, 133(7): 695-700. doi:10.1177/00034894241252231
[12]	Çelikal Ö, Günaydın RÖ, Akyol MU. Evaluation of the effects of three different tracheotomy techniques on tracheal complications and decannulation[J]. Auris Nasus Larynx, 2022, 49(4): 670-675. doi:10.1016/j.anl.2021.11.016
[13]	Ha TN, Jain S, Schuman A, et al. Pediatric tracheotomy stomal maturation and tracheocutaneous fistulas[J]. Laryngoscope, 2024, 134(6): 2941-2944. doi:10.1002/lary.31271
[14]	Ha TA, Goyal M, Ongkasuwan J. Duration of tracheostomy dependence and development of tracheocutaneous fistula in children[J]. Laryngoscope, 2017, 127(12): 2709-2712. doi:10.1002/lary.26718
[15]	Al-Faleh M, Alsheef H, Al-Anzi O, et al. Pediatric tracheostomy: a quality-of-life assessment study in Saudi Arabia[J]. Cureus, 2023, 15(10): e47235. doi:10.7759/cureus.47235
[16]	Namavarian A, Levy BB, Tepsich M, et al. Percutaneous tracheostomy in the pediatric population: a systematic review[J]. Int J Pediatr Otorhinolaryngol, 2024, 177: 111856. doi:10.1016/j.ijporl.2024.111856
[17]	Sanders CD, Guimbellot JS, Muhlebach MS, et al. Tracheostomy in children: Epidemiology and clinical outcomes[J]. Pediatr Pulmonol, 2018, 53(9): 1269-1275. doi:10.1002/ppul.24071
[18]	Li D, Hao SY, Wu Z, et al. Primary medulla oblongata teratomas[J]. J Neurosurg Pediatr, 2014, 14(3): 296-300. doi:10.3171/2014.6.peds1423
[19]	汪照炎, 吴皓, 黄琦, 等. 颈静脉孔区肿瘤术后后组脑神经损伤的评估和处理[J]. 临床耳鼻咽喉头颈外科杂志, 2007, 21(15): 682-684. doi:10.3969/j.issn.1001-1781.2007.15.003 WANG Zhaoyan, WU Hao, HUANG Qi, et al. Functional evaluation and management of lower cranial nerve injuring after jugular foramen tumor surgery[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2007, 21(15): 682-684. doi:10.3969/j.issn.1001-1781.2007.15.003
[20]	董康, 钟东, 尹浩扬, 等. 多学科协作、多技术融合手术治疗颈静脉孔区肿瘤[J]. 中华脑科疾病与康复杂志(电子版), 2020, 10(4): 209-217. doi:10.3877/cma.j.issn.2095-123X.2020.04.004.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed