外科治疗纵隔甲状腺肿所致气管压迫：是否需要体外循环？
Surgical management of tracheal compression caused by mediastinal goiter: is extracorporeal circulation requisite?
机构信息
Department of General Thoracic Surgery (Drs Wang, Lin, Yang and Wang), Second Affiliated Hospital, Medical College of Ji'nan University , Shenzhen People's Hospital, Shenzhen518020, Guangdong Province, China; Department of Cardiovascular Surgery (Dr Sun), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China.
出版信息
J Thorac Dis. 2009 Dec;1(1):48-50.
OBJECTIVE
To investigate the surgical and anesthetic management strategy of tracheal compression caused by mediastinal goiter.
METHODS
We retrospectively analyzed a patient with an anterior mediastinal mass in whom cardiopulmonary bypass was kept on standby via femoral vessels before induction of anesthesia. Bronchoscope guided tracheal intubation was done and tumor was removed via a cervical approach. Relative literature was reviewed.
RESULTS
CPB via femoral vessels before induction of anesthesia help the patient recover from the perioperative period safely. While bronchoscope slipped beyond the obstruction smoothly and spent less time. The apparently narrow trachea easily distended and did not impair passage of the tube into the trachea opposed to being predicted preoperatively. The histopathological diagnosis confirmed the tumor as a nodular goiter with the formation of hematoma.
CONCLUSIONS
CPB via femoral vessels before induction of anesthesia during surgical management of tracheal compression caused by mediastinal goiter is justified while bronchoscope guided tracheal intubation to establish the tracheal patency is a safe and feasible alternative.
目的
探讨胸骨后甲状腺肿所致气管压迫的手术和麻醉管理策略。
方法
我们回顾性分析了 1 例术前通过股血管保持体外循环的前纵隔肿块患者。通过支气管镜引导进行气管插管，并通过颈部入路切除肿瘤。同时回顾了相关文献。
结果
麻醉诱导前通过股血管进行 CPB 有助于患者安全度过围手术期。同时支气管镜顺利滑过阻塞部位，花费时间更少。明显狭窄的气管很容易扩张，并且与术前预测相反，不会妨碍将管子插入气管。组织病理学诊断证实肿瘤为结节性甲状腺肿，伴血肿形成。
结论
胸骨后甲状腺肿所致气管压迫的手术治疗中，麻醉诱导前通过股血管进行 CPB 是合理的，而支气管镜引导下气管插管以建立气管通畅是一种安全可行的替代方法。
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