Louville Y, Dumouchel A, Jarreau M M, Fimeyer A, Cara M
Ann Anesthesiol Fr. 1976;11(7):769-75.
Resection and anastomosis of the trachea or the tracheal bifurcation, raises numerous problems, which will be discussed in a series of 81 patients: -there is more or less marked ventilatory insufficiency related to the degree of the stenosis, and difficulties of expectoration responsible for retention of sputum; -per-operative ventilation. One must choose between an intubation catheter of small caliber in order to overcome the stenosis, or a large catheter to remain above it. The problem is all the more delicate to solve when the stenosis is tighter and higher; -during the period when the trachea is open, the surgeon must intubate the central part of the trachea with a sterile catheter. If the division is low, it is necessary to intubate the main bronchi or one only, and then create a marked shunt effect which would be ill-supported by the patient; -It is advisable to remove the catheter at the end of the operation. Awakening should be perfect in order to cough to be immediately efficacious in a patient who often has to remain with his head flexed forwards.
气管或气管分叉处的切除与吻合会引发诸多问题,这将在一组81例患者中进行讨论:与狭窄程度相关的或多或少明显的通气不足,以及咳痰困难导致痰液潴留;术中通气。必须在为克服狭窄而选用小口径插管导管,还是为留在狭窄上方而选用大导管之间做出选择。当狭窄更严重且位置更高时,解决这个问题就更加棘手;在气管开放期间,外科医生必须用无菌导管插入气管中部。如果分割位置较低,则有必要插入主支气管或仅插入一根主支气管,然后会产生明显的分流效应,而患者难以承受;建议在手术结束时拔除导管。患者通常需头部向前屈曲,因此苏醒应完全,以便咳嗽能立即有效。