Division of Thoracic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato, Tokyo, 105-0003, Japan.
Gen Thorac Cardiovasc Surg. 2021 Feb;69(2):401-404. doi: 10.1007/s11748-020-01480-6. Epub 2020 Sep 5.
Giant mediastinal tumors may cause fatal respiratory failure or circulatory collapse at the time of induction of general anesthesia and sometimes require extracorporeal life support. However, it is unclear whether preoperative percutaneous drainage of tumor contents for a giant mediastinal cystic teratoma reduces these risks. We report a case of a giant mediastinal cystic teratoma in which general anesthesia could be safely induced without extracorporeal life support by preoperative percutaneous drainage that reduced most of the tumor volume under local anesthesia. A 41-year-old woman diagnosed with a ruptured giant mediastinal teratoma required urgent surgery. To avoid circulatory collapse, preoperative percutaneous drainage of the tumor contents was performed, which successfully evacuated most of the tumor volume. General anesthesia was induced without any problem, and mediastinal tumorectomy was performed. We argue that it is worth attempting percutaneous drainage of tumor contents before cannulation of extracorporeal life support.
巨大的纵隔肿瘤在全身麻醉诱导时可能导致致命性的呼吸衰竭或循环衰竭，有时需要体外生命支持。然而，对于巨大纵隔囊性畸胎瘤，术前经皮穿刺引流肿瘤内容物是否能降低这些风险尚不清楚。我们报告了一例巨大纵隔囊性畸胎瘤的病例，通过术前经皮穿刺引流，在局部麻醉下降低了大部分肿瘤体积，安全地进行了全身麻醉，无需体外生命支持。一名 41 岁女性被诊断为破裂的巨大纵隔畸胎瘤，需要紧急手术。为避免循环衰竭，先进行了肿瘤内容物的术前经皮引流，成功地排出了大部分肿瘤体积。全身麻醉诱导没有任何问题，随后进行了纵隔肿瘤切除术。我们认为，在进行体外生命支持插管之前，尝试经皮穿刺引流肿瘤内容物是值得的。
