Petrella Francesco, Borri Alessandro, Casiraghi Monica, Cavaliere Sergio, Donghi Stefano, Galetta Domenico, Gasparri Roberto, Guarize Juliana, Pardolesi Alessandro, Solli Piergiorgio, Tessitore Adele, Venturino Marco, Veronesi Giulia, Spaggiari Lorenzo
Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy
Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
Multimed Man Cardiothorac Surg. 2014 May 27;2014:mmu006. doi: 10.1093/mmcts/mmu006.
Palliative airway treatments are essential to improve quality and length of life in lung cancer patients with central airway obstruction. Rigid bronchoscopy has proved to be an excellent tool to provide airway access and control in this cohort of patients. The main indication for rigid bronchoscopy in adult bronchology remains central airway obstruction due to neoplastic or non-neoplastic disease. We routinely use negative pressure ventilation (NPV) under general anaesthesia to prevent intraoperative apnoea and respiratory acidosis. This procedure allows opioid sparing, a shorter recovery time and avoids manually assisted ventilation, thereby reducing the amount of oxygen needed, while maintaining optimal surgical conditions. The major indication for NPV rigid bronchoscopy at our institution has been airway obstruction by neoplastic tracheobronchial tissue, mainly treated by laser-assisted mechanical dissection. When strictly necessary, we use silicone stents for neoplastic or cicatricial strictures, reserving metal stents to cover tracheo-oesophageal fistulae. NPV rigid bronchoscopy is an excellent tool for the endoscopic treatment of locally advanced tumours of the lung, especially when patients have exhausted the conventional therapeutic resources. Laser-assisted mechanical resection and stent placement are the most effective procedures for preserving quality of life in patients with advanced stage cancer.
姑息性气道治疗对于改善患有中央气道阻塞的肺癌患者的生活质量和延长生存期至关重要。硬质支气管镜已被证明是为这类患者提供气道通路和控制的极佳工具。在成人支气管学中，硬质支气管镜的主要适应证仍然是由于肿瘤性或非肿瘤性疾病导致的中央气道阻塞。我们常规在全身麻醉下使用负压通气（NPV）以预防术中呼吸暂停和呼吸性酸中毒。该操作可减少阿片类药物的使用，缩短恢复时间，并避免手动辅助通气，从而减少所需氧气量，同时维持最佳手术条件。在我们机构，NPV硬质支气管镜的主要适应证是肿瘤性气管支气管组织导致的气道阻塞，主要通过激光辅助机械切除进行治疗。在严格必要时，我们使用硅酮支架治疗肿瘤性或瘢痕性狭窄，保留金属支架用于覆盖气管食管瘘。NPV硬质支气管镜是内镜治疗局部晚期肺癌的极佳工具，尤其是当患者已用尽传统治疗资源时。激光辅助机械切除和支架置入是晚期癌症患者维持生活质量的最有效方法。
