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Tracheostomy is a procedure in which an artificial opening is created in the throat to assist with patient's breathing or to create an alternate airway.
气管切开术是一种在咽喉处建立一个人工开口以帮助患者呼吸或创造另一个气道的过程。
It is a fairly common procedure in patients with prolonged ICU stay or ventilator support.
对于需要长时间住ICU或呼吸机支持的患者来说，这是一个相当常见的手术。
Indications for Tracheostomy
气管切开术的适应症
Tracheostomy may be needed when there is
当出现以下情况时，气管切开术是必要的：
(1) some sort of upper airway obstruction, e.g. cancer of the larynx, laryngeal edema etc;
(1)上气道有某种阻塞，如喉癌、喉头水肿等；
(2) if patient is unable to remove respiratory secretions, e.g. coma, respiratory muscles paralysis.
(2) 如果病人不能清除呼吸分泌物，例如昏迷、呼吸肌肉麻痹。
In such cases, tracheostomy allows suctioning of the secretions and the cuff of the tracheostomy reduces further aspiration of secretions.
在这种情况下，气管切开术可以吸入分泌物，而气管切开术的导管可以减少进一步的分泌物吸入。
(3) If patient has respiratory insufficiency, e.g. chronic lung diseases, then tracheostomy might help oxygen ventilation by reducing respiratory dead space.
(3)如患者有呼吸功能不全，如慢性肺部疾病，则气管切开术可减少呼吸死腔，帮助氧通气。
(4) Prophylactic measures, in a patient on prolonged mechanical ventilation via endotracheal tube, there is a risk for tracheal stenosis.
(4)预防措施：长时间经气管内插管进行机械通气的患者，存在气管狭窄的风险。
So in such patients tracheostomy is done.
因此，这样的病人，要做气管切开术。
(5) As part of another procedure
(5) 作为另一个手术的一部分
Sometimes tracheostomy is done to gain access to airway for general anesthesia, or as a precautionary measure in some patients who undergo an extensive neck surgery.
有时气管切开术是为了在全身麻醉时获得气道，或者是在一些接受广泛颈部手术的患者中作为一种预防措施。
Type of Tracheostomy
气管切开术的类型
There are various types of tracheostomy procedures, depending on the circumstances of the patient and the treatment intent.
根据病人的情况和治疗目的，气管切开术的方法有很多种。
Similarly, there are various types of tracheostomy tubes each with specific functions.
同样，气管切开术所用的导管也有不同的种类，每种都有特定的功能。
The common types of tracheostomy procedures are
气管切开术的常见类型有：
(1) Emergency Tracheostomy
(1) 紧急气管切开术
(2) Elective Tracheostomy
(2) 选择性气管切开术
(3) Permanent Tracheostomy
(3) 永久性性气管切开术
(4) Percutaneous Tracheostomy
(4) 经皮气管切开术
(5) Mini Tracheostomy, also known as cricothyroidotomy.
(5) 微创气管切开术，也称为环甲膜切开术。
Tracheostomy can also be classified as high, mid or low; depending on the level at which it is inserted into the trachea.
气管切开术也可分为高位、中位或低位，具体取决于插入气管的水平。
Different varieties of tracheostomy tubes include cuffed, non cuffed, double lumen tubes, tubes with speaking valves, metallic tubes, and so on.
不同种类的气管造口管包括带套囊的管、没有套囊的管、双腔管、带发声阀的管、金属管等。
Procedure
气管切开术过程
The procedure is preferably done under general anesthesia, but emergency cases may necessitate local anesthesia only.
手术最好在全身麻醉下进行，但紧急情况可能只需要局部麻醉。
There are variations on the technique of the procedure, but generally these are the steps: The patient is put in a supine position with neck extended.
手术技术各有不同，但通常都是这样的步骤：病人取仰卧位，头后仰。
Skin incision, which may be transverse or longitudinal, is given on the neck.
颈部的皮肤切口可以是横向的，也可以是纵向的。
Subcutaneous fat and platysma are cut.
切除皮下脂肪和颈阔肌。
Strap muscles of the neck are retracted or dissected away.
将颈部的带状肌肉缩回或剥离。
If thyroid gland is encountered, then it is displaced upwards, or may be cut.
如果遇到甲状腺，则向上移位，或可切除。
Any blood vessels encountered along the way are ligated.
操作过程中遇到的任何血管都要结扎。
Incision is given on the trachea.
在气管上切开。
A hole is made and the tracheostomy tube is inserted, preferably through the second or third tracheal ring.
开孔并插入气管造口管，最好通过第二或第三气管环处插入。
The skin incision is closed and the tracheostomy tube is secured to the skin via stitches or simply tied around the neck.
皮肤切口关闭，气管造口管通过缝合或简单地绑在脖子上固定在皮肤上。
