Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Anesth Analg. 2011 Mar;112(3):688-92. doi: 10.1213/ANE.0b013e318206917a. Epub 2011 Feb 8.
Aberrant tracheobronchial anatomy is reported at an incidence of approximately 10% and most frequently involves the segmental and subsegmental bronchi. The most relevant abnormality to the practice of anesthesiology is the presence of a tracheal bronchus. Although typically an asymptomatic finding during bronchoscopy, a tracheal bronchus has important implications for airway management and lung isolation. Coexisting abnormalities may further complicate lung isolation. We describe a patient with a tracheal bronchus, coexisting with a left-shifted carina and apically retracted left mainstem bronchus, presenting for right extrapleural pneumonectomy. Attempts to place a left-sided double-lumen endotracheal tube were unsuccessful. We discuss our solution, review the literature, and present potential solutions for lung isolation in patients with a tracheal bronchus.
异常的气管支气管解剖结构的发生率约为 10%，最常涉及节段和亚段支气管。与麻醉学实践最相关的异常是存在气管支气管。尽管在支气管镜检查期间通常是无症状的发现，但气管支气管对气道管理和肺隔离具有重要意义。并存的异常可能会进一步使肺隔离复杂化。我们描述了一名患者存在气管支气管，同时伴有左移隆突和左上叶主支气管后缩，该患者拟行右侧胸膜外肺切除术。尝试放置左侧双腔气管内导管均未成功。我们讨论了我们的解决方案，回顾了文献，并为气管支气管患者的肺隔离提供了潜在的解决方案。
