| 摘要 |
A method and device (10) for providing an ostomy (102) through the wall (100) of the trachea. The method employs a balloon catheter (16) including an inflatable balloon (18), and entails percutaneously inserting the tip (56) of a wire guide (54) through the tracheal wall (100) so that the wire guide (54) lies across the tracheal wall (100); positioning the catheter (16) over the wire guide (54); advancing the catheter (16) along the wire guide (54) until the balloon (18) lies across the tracheal wall (100); and inflating the balloon (18) to atraumatically dilate a portion of the tracheal wall (100), thereby forming an ostomy (102). The method desirably includes the further steps of deflating the balloon (18) and inserting a tracheal tube (20) into the ostomy (102). The tracheal tube (20) can be positioned in the open ostomy (102) after removing the balloon (18) from the ostomy (102). However, the method is preferably carried out employing a device (10) having a dilator tube (12) which carries the catheter (16) and tracheal tube (20) on it. Such a construction allows the dilator tube (12), the balloon catheter (16) and the tracheal tube (20) to be advanced on the wire guide (54) together. The tracheal tube (20) can include an inflatable circumferential cuff (24) on it, providing a seal between the tracheal tube (20) and the tracheal wall (100). The diameter of the balloon (18) preferably is at least equal to, and more preferably is slightly greater than, the maximum diameter of any portion of the tracheal tube (20) (such as the uninflated cuff (24)) to be inserted into the ostomy (102). The method and device (10) of the present invention are particularly advantageous in that the ostomy (102) can be formed atraumatically and enlarged without risk of perforating the rear of the trachea, and in that the close dilation or slight overdilation of the ostomy (102), along with the taper of the distal end (14) of the dilator tube (12), protect the cuff (24) from damage during insertion of the tracheal tube (20) through the ostomy (102). <IMAGE> |
