Cai Q, Liu Y H, Wu K L, Wu J, Zhao Y, Yao C Y
Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 Dec 5;31(23):1806-1809. doi: 10.13201/j.issn.1001-1781.2017.23.007.
To investigate the effect of preoperative airway treatment and postoperative asphyxiation preventive measures in patients with tumors invasion in the cervical tracheal. The clinical date of 35 patients with different degree of tumors invasion in the cervical tracheal were analyzed retrospectively. Anesthesia including normal endotracheal intubation anesthesia, awake intubation anesthesia with visual laryngoscope assisted after topical anesthesia, intubation anesthesia with preoperative tracheotomy, intubation anesthesia after transection of trachea and anesthesia with extracoporeal circulation was selected according to the patient's situation such as whether exist forced position, or the extent of dyspnea, or the range of recurrent tumor. Preventive tracheotomy or fistulization was performed according to the patients' tracheal involvement and the choice of operation and general condition during the operation. All 35 patients were successfully anesthetized, 17 of whom had no dyspnea or forced position, this kind patients were all anesthesia successfully, and 3 of them underwent prophylactic tracheotomy. Sixteen cases of nonrecurrent tumor with forced position, 15 patients were accepted awake anesthesia successfully with visual laryngoscope assisted after topical anesthesia, 1 patient who cannot be intubated or done tracheotomy is completed with extracorporeal circulation; prophylactic tracheotomy or tracheostomy was performed in this group. Of 2 cases of recurrent tumor with forced posture, preoperative tracheal intubation failed, 1 case was intubated after emergency transection of trachea, 1 case was successfully intubated by emergency tracheotomy before operation and 2 cases received postoperative tracheostomy. In this study, no serious complications such as massive bleeding, asphyxia and cardiovascular accident occurred after the operation. The preoperative airway management of patients whose tumors involves the cervical tracheal and whether tracheotomy or ostomy need to prevent asphyxia or not should be based on the nature of the tumor such as whether is recurrent, the extent of trachea involvement and whether to merge the OSAHS. Only by considering the various factors that affect the airway synthetically, an effective method can be adopted to ensure the safety of the operation.
探讨术前气道处理及术后窒息预防措施对肿瘤侵犯颈段气管患者的影响。回顾性分析35例不同程度肿瘤侵犯颈段气管患者的临床资料。根据患者是否存在强迫体位、呼吸困难程度、肿瘤复发范围等情况，选择包括普通气管内插管麻醉、表面麻醉后可视喉镜辅助清醒插管麻醉、术前气管切开插管麻醉、气管横断后插管麻醉及体外循环麻醉等。术中根据患者气管受累情况、手术选择及全身状况行预防性气管切开或造瘘。35例患者均麻醉成功，其中17例无呼吸困难或强迫体位，此类患者均麻醉成功，3例行预防性气管切开。16例非复发性肿瘤伴强迫体位患者，15例表面麻醉后可视喉镜辅助下清醒麻醉成功，1例无法插管或气管切开者行体外循环完成手术；该组均行预防性气管切开或气管造瘘。2例复发性肿瘤伴强迫体位患者，术前气管插管失败，1例紧急气管横断后插管，1例术前紧急气管切开成功插管，2例术后气管造瘘。本研究术后未发生大出血、窒息及心血管意外等严重并发症。对于肿瘤侵犯颈段气管患者的术前气道管理及是否需要气管切开或造瘘预防窒息，应根据肿瘤性质如是否复发、气管受累程度及是否合并OSAHS等综合考虑，只有综合考虑影响气道的各种因素，采取有效的方法，才能确保手术安全。
