Fernández Núñez J A, Unzueta Merino M C, Alvarez Escudero J, Villar Landeira J M
Servicio de Anestesiología, Hospital de la Santa Creu i Sant Pau, Barcelona.
Rev Esp Anestesiol Reanim. 1990 Jan-Feb;37(1):32-6.
A patient with carcinoma of the lower third of esophagus suffered an extensive tracheal tear during transhiatal esophagectomy without thoracotomy, with severe impairment of ventilatory and hemodynamic status. A right thoracotomy was required for the repair of the tracheal lesion, which extended to the origin of left bronchus. During the maneuvers for bronchial intubation, the hypoxia worsened and cardiac arrest caused by ventricular fibrillation appeared. The arrhythmia was reverted. Operative mortality of transhiatal esophagectomy without thoracotomy is 8%. Pneumothorax is the most common operative complication. Tracheal laceration is reported in 1% of cases; usually it is not severe and is easily treated, although it can have significant severity and result in death as in the present case. After the operation, the patient persisted hemodynamically unstable, developing a new gasometric deterioration and bilateral pleural effusion, with impairment of coagulation. The patient died 39 hours after operation. The anesthetic management of peroperative tracheal tear is reviewed.
一名食管下三分之一段癌患者在非开胸经裂孔食管切除术中发生广泛气管撕裂，通气和血流动力学状态严重受损。因气管损伤延伸至左主支气管起始部，需行右开胸手术进行修复。在进行支气管插管操作时，缺氧情况恶化，出现心室颤动导致的心搏骤停。心律失常得以纠正。非开胸经裂孔食管切除术的手术死亡率为8%。气胸是最常见的手术并发症。气管撕裂在1%的病例中被报道；通常并不严重且易于治疗，尽管如本例所示，其可能具有严重程度并导致死亡。术后，患者血流动力学持续不稳定，出现新的气体测量恶化和双侧胸腔积液，并伴有凝血功能障碍。患者于术后39小时死亡。本文对术中气管撕裂的麻醉管理进行了综述。
