Thiam Ndeye Fatou, Diom Evelyne Siga, Ndiaye Cire, Sy Abdou
Service d'ORL, CCF, Hôpital Militaire de Ouakam, Dakar, Sénégal.
Service d'ORL-CCF, Hôpital Fann, Dakar, Sénégal.
Pan Afr Med J. 2017 Oct 20;28:168. doi: 10.11604/pamj.2017.28.168.12792. eCollection 2017.
We report 3 rare cases of post-intubation tracheal lacerations detected during cervical spine surgery. Our study involved 3 patients aged 27, 30 and 42 years admitted to the operating room for total thyroidectomy for heterogeneous multinodular goitre under general anesthesia. Orotracheal intubation using 7.5 rigid guide probe and balloon cuff was performed. During surgery we discovered a protrusion of the balloon cuff at the surgical site through posterolateral tracheal rupture. The treatment was based on closure of the tracheal rupture in 2 cases and on surgical abstention in the third case, followed by a drainage of the thyroid lodge. The postoperative course was uneventful. Post-intubation tracheal lacerations are rare. Intraoperative detection during cervical spine surgery is exceptional. They have multiple causes: intubation difficulties, membranous rupture caused by probe beak, by a rigid guide, coughing effort with inflated balloon at the awakening, balloon hyperinflation, structural and anatomical changes of the trachea in patients with chronic goiter. There is no consensus about treatment.
我们报告了3例在颈椎手术过程中发现的插管后气管撕裂的罕见病例。我们的研究涉及3名年龄分别为27岁、30岁和42岁的患者,他们因异质性多结节性甲状腺肿在全身麻醉下进入手术室接受全甲状腺切除术。使用7.5号硬导探头和带气囊的气管插管进行经口气管插管。手术过程中,我们通过气管后外侧破裂处发现气囊在手术部位突出。2例患者的治疗基于气管破裂的缝合,第3例患者采取手术弃权,随后进行甲状腺窝引流。术后过程顺利。插管后气管撕裂很少见。在颈椎手术中术中检测到则更为罕见。其病因有多种:插管困难、探头喙部、硬导引起的膜性破裂、苏醒时气囊充气状态下的咳嗽用力、气囊过度充气、慢性甲状腺肿患者气管的结构和解剖变化。关于治疗尚无共识。