Divatia J V, Upadhye S M, Sareen R
Department of Anaesthesia, Tata Memorial Hospital, Bombay, India.
Anaesthesia. 1992 Jun;47(6):486-9. doi: 10.1111/j.1365-2044.1992.tb02271.x.
Two patients presented with almost total obliteration of the pharynx. In one, a membrane developed after corrosive poisoning; in the other, the oropharynx was filled with a dense cicatrix in the sclerosing phase of rhinoscleroma. In both patients, a single opening in the membrane provided access to both the larynx and oesophagus. Fibreoptic intubation allowed both a thorough assessment of the pathology and subsequently the passage of a cuffed tracheal tube to secure the airway. To overcome the problem of respiratory obstruction while the fibrescope passed through the opening in the membrane, either rapid intubation, or a technique using pre-oxygenation and voluntary hyperventilation followed by breath-holding during bronchoscopy, was used. The thin calibre and manoeuvrability of the flexible fibreoptic bronchoscope makes fibreoptic intubation an excellent technique of airway management in cicatricial membranes of the pharynx.
两名患者出现几乎完全闭塞的咽部。其中一名患者在腐蚀性中毒后形成了一层膜；另一名患者在鼻硬结病的硬化期，口咽充满了致密的瘢痕组织。两名患者的膜上都有一个单一开口，可通向喉部和食管。纤维光导插管既能全面评估病变情况，随后又能插入带气囊的气管导管以确保气道安全。为解决纤维内镜通过膜上开口时的呼吸梗阻问题，采用了快速插管，或先预充氧、进行自主过度通气，然后在支气管镜检查期间屏气的技术。可弯曲纤维光导支气管镜的细管径和可操作性，使纤维光导插管成为咽部瘢痕膜气道管理的一项出色技术。
