Nishikawa Haruko, Inagawa Gaku
Masui. 2016 Feb;65(2):150-2.
We report the case of a mass in the pharynx found at the induction of general anesthesia that vanished postoperatively. A 46-year-old man underwent abdominal surgery. After the induction of general anesthesia, there was a mass occupying his pharynx and we could see neither the vocal cords nor the epiglottis using a Macintosh laryngoscope. Airwayscope (AWS) enabled us to successfully intubate the trachea. On postoperative examination, there was no mass on his pharynx. Imaging studies of the esophagus revealed a polyp suspected as being a fibrovascular polyp (FVP) arising from the upper esophagus. Three months later, excision of the polyp was planned. Awake intubation with AWS was planned so that if the polyp was regurgitated, he could swallow it Intubation was uneventful without regurgitation of the polyp. At the beginning of surgery, the polyp was not found in the pharynx, but was easily regurgitated by air supplied by the endoscope. FVPs are rare benign esophageal tumors and most originate from the cervical esophagus. If a polyp is regurgitated, obstruction of the airway may occur, and asphyxiation and sudden death have been reported. The fatal complication of airway obstruction requires anesthesiologists to be aware of FVP.
我们报告一例在全身麻醉诱导时发现的咽部肿物，术后消失。一名46岁男性接受腹部手术。全身麻醉诱导后，有一肿物占据其咽部，使用麦氏喉镜既看不到声带也看不到会厌。气道镜（AWS）使我们能够成功地进行气管插管。术后检查发现，其咽部没有肿物。食管影像学检查发现一个疑似为起源于食管上段的纤维血管性息肉（FVP）的息肉。三个月后，计划切除该息肉。计划使用AWS进行清醒插管，以便如果息肉反流，患者能够将其咽下。插管过程顺利，息肉未发生反流。手术开始时，在咽部未发现息肉，但在内窥镜提供的空气作用下，息肉很容易反流出来。FVP是罕见的食管良性肿瘤，大多数起源于颈段食管。如果息肉发生反流，可能会导致气道梗阻，并且已有窒息和猝死的报道。气道梗阻这一致命并发症要求麻醉医生对FVP有所警惕。
