Hanagiri T, Shirakusa T, Okabayashi K, Ishikura Y, Shigematsu A, Sata T
Second Department of Surgery, University of Occupational and Environmental Health, School of Medicine, Kitakyusyu, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1992 Aug;40(8):1285-90.
A 43-year-old male was admitted to our hospital with chief complaints of stridor and dyspnea. Bronchoscopy revealed a tumor obstructing almost the whole lumen of the trachea. As it was impossible to insert an endotracheal tube into the distal site of the stenosis in the mediastinum, we used partial cardiopulmonary bypass to maintain gas exchange. The axillary artery and the femoral artery and vein were cannulated for the bypass using local anesthesia. During 105 minutes of bypass, the PaO2 value was good but the PaCO2 value increased up to 70 mmHg. After the trachea was opened, the anesthetic gas was administered across the operative field through the endotracheal tube and the cardiopulmonary bypass was discontinued. Tracheolaryngectomy and permanent tracheostomy with relocation to the right and caudal side of the brachiocephalic artery was performed successfully. The post operative course was very smooth. The patient has been well for 6 months since the surgery. Partial cardiopulmonary bypass proved to be useful for maintaining gas exchange during reconstructive surgery of the trachea. We treated a case of tracheal carcinoma by resection while using partial cardiopulmonary bypass. We believe this is the ninth such case reported Japanese literature.
一名43岁男性因喘鸣和呼吸困难为主诉入院。支气管镜检查发现肿瘤几乎阻塞了整个气管腔。由于无法将气管内导管插入纵隔狭窄部位的远端，我们采用部分体外循环来维持气体交换。在局部麻醉下，通过腋动脉、股动脉和股静脉进行体外循环插管。在105分钟的体外循环期间，动脉血氧分压（PaO2）值良好，但动脉血二氧化碳分压（PaCO2）值升至70 mmHg。气管切开后，通过气管内导管在术野给予麻醉气体，并停止体外循环。成功实施了全喉气管切除术及永久性气管造口术，并将气管造口重新定位至头臂动脉右侧和尾侧。术后过程非常顺利。自手术以来，患者已健康存活6个月。部分体外循环被证明在气管重建手术中对维持气体交换有用。我们采用部分体外循环进行切除治疗了一例气管癌。我们认为这是日本文献报道的第九例此类病例。
