Zhao Wei, Li Cheng-Hui, Jia Nai-Guang, Fei Hong-Liang, Zhao Feng-Rui
Department of Anesthesia, China-Japan Friendship Hospital, Beijing 100029, China.
Zhonghua Wai Ke Za Zhi. 2008 Jul 1;46(13):981-4.
To analyze and discuss the anesthetic methods and processes for the operations including long-segment resection of the trachea and one-stage anastomosis or reconstruction with artificial trachea.
The clinical data of 25 cases from January 1987 to August 2007 with trachea diseases were analyzed retrospectively. There were 10 cases with benign diseases and 15 cases with malignant diseases. All cases represented tracheal stenosis. Some cases represented severe dyspnea. The length of the tracheal lesions was from 2.5 to 7.5 cm. The longest resection of the trachea was 8.0 cm. Direct reanastomosis were carried out in 14 cases. Reconstruction with artificial trachea were carried out in 7 cases. Thirteen cases underwent general anesthesia with endotracheal intubation only, while 2 cases were assisted with artificial cardiopulmonary bypass. Eight cases were intubated via existed tracheotomy. Two cases received bedside tracheotomy with local anesthesia. Two cases were assisted with high frequency jet ventilation. During the operation, a tube was inserted into the distal trachea or contralateral main bronchus to maintain anesthesia and ventilation after the trachea resection.
All of the 25 patients had good outcome. There was no death caused by anesthesia or operation. However, transient lower SaO2 was found in 2 cases because of the difficult intubation of left main bronchus after the resection of the trachea. One case was ventilated with only lower lobe because of the extra-deep intubation of the left main bronchus. Anastomosis dehiscence happened in 1 case when the non-balloon trachea tube was used immediately after the operation.
The mortality of anesthesia for tracheal operation are quite high. Therefore, individual treatment with carefully-designed anesthetic and operative protocol, and good communications and cooperation between anesthesiologists and surgeons is the key factor for the success of anesthesia and operation.
分析和探讨气管长段切除并一期吻合或人工气管重建等手术的麻醉方法及过程。
回顾性分析1987年1月至2007年8月25例气管疾病患者的临床资料。其中良性疾病10例，恶性疾病15例。所有病例均表现为气管狭窄，部分病例有严重呼吸困难。气管病变长度为2.5至7.5厘米，气管最长切除长度为8.0厘米。14例行直接吻合术，7例行人工气管重建术。13例仅行气管内插管全身麻醉，2例辅助体外循环。8例经已有的气管切开处插管，2例在局部麻醉下行床边气管切开，2例辅助高频喷射通气。术中，气管切除后经远端气管或对侧主支气管插入导管以维持麻醉和通气。
25例患者均预后良好，无麻醉或手术导致的死亡。然而，2例患者因气管切除后左主支气管插管困难出现短暂低氧饱和度。1例因左主支气管插管过深仅下叶通气。1例术后立即使用非气囊气管导管出现吻合口裂开。
气管手术麻醉死亡率较高。因此，精心设计麻醉和手术方案进行个体化治疗，以及麻醉医生与外科医生之间良好的沟通与合作是麻醉和手术成功的关键因素。
