Lang György, Ghanim Bahil, Hötzenecker Konrad, Klikovits Thomas, Matilla Jose Ramon, Aigner Clemens, Taghavi Shahrokh, Klepetko Walter
Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
Eur J Cardiothorac Surg. 2015 Feb;47(2):250-5; discussion 256. doi: 10.1093/ejcts/ezu162. Epub 2014 Apr 16.
The published experience with advanced broncho-plastic procedures performed with extracorporeal membrane oxygenation (ECMO) support is very limited. We examined our results to assess the risks and benefits of this approach.
We retrospectively analysed all patients with thoracic malignancies who underwent complex tracheo-bronchial reconstruction under ECMO support in our department between 2001 and 2013.
Ten patients (age range 21-81 years, mean 54 ± 11 years) underwent complex tracheo-bronchial reconstructions under veno-arterial ECMO support. In 7 patients, the underlying pathology was non-small-cell lung cancer, in 2 cases carcinoid tumour and in 1 case adenoid cystic carcinoma. ECMO cannulation was central (n = 7) or peripheral (n = 3). Mean time on bypass was 113 ± 17 min (range 70-135 min). A complete resection (R0) was achieved in 8 patients (80%). There was no perioperative mortality. Patients were discharged from the hospital after 7-52 days (median 11 days). Median time on ICU was 1 day (range 1-36 days). There was no complication related to the use of ECMO in this series. Mean follow-up time was 1694 ± 1385 days (range 12-4338). The 1-, 3- and 5-year Kaplan-Meier survival was 100, 74 and 56%, respectively.
Based on this experience, we consider veno-arterial ECMO support as a safe and valuable approach for complex airway surgery.
体外膜肺氧合（ECMO）支持下进行的晚期支气管成形手术的已发表经验非常有限。我们研究了我们的结果，以评估这种方法的风险和益处。
我们回顾性分析了2001年至2013年间在我们科室接受ECMO支持下进行复杂气管支气管重建的所有胸段恶性肿瘤患者。
10例患者（年龄范围21 - 81岁，平均54±11岁）在静脉 - 动脉ECMO支持下进行了复杂气管支气管重建。7例患者的潜在病理为非小细胞肺癌，2例为类癌肿瘤，1例为腺样囊性癌。ECMO插管为中心插管（n = 7）或外周插管（n = 3）。平均体外循环时间为113±17分钟（范围70 - 135分钟）。8例患者（80%）实现了根治性切除（R0）。无围手术期死亡。患者在7 - 52天（中位数11天）后出院。在重症监护病房（ICU）的中位时间为1天（范围1 - 36天）。本系列中未出现与ECMO使用相关的并发症。平均随访时间为1694±1385天（范围12 - 后4338天）。1年、3年和5年的Kaplan - Meier生存率分别为100%、74%和56%。
基于这一经验，我们认为静脉 - 动脉ECMO支持是复杂气道手术的一种安全且有价值的方法。
