Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
Interact Cardiovasc Thorac Surg. 2021 Oct 4;33(4):649-651. doi: 10.1093/icvts/ivab124.
Tracheal sleeve pneumonectomy for lung cancer is an old technique, and it is reserved for exceptional cases with tracheal carina involvement. Intra-operative airways management of this operation is incredibly complex, involving thoracic surgeons, anaesthesiologists and pulmonologists. We report a case of a 38-year-old male with no clinical history, referred to our department for an adenoid-cystic carcinoma involving distal trachea, carina and main right bronchus. Tracheal sleeve pneumonectomy was performed using extra-corporeal membrane oxygenation (ECMO). A veno-venous ECMO circuit was established through a heparin-coated percutaneous cannula in the right femoral vein and a heparin-coated percutaneous cannula in the internal right jugular vein by ultrasound assistance. No major complications occurred, and the patient was discharged after 30-day bronchoscopic control, showing the absence of fistula and negativity of the methylene blue test. ECMO-assisted surgery ensures adequate respiratory support, haemodynamic stability, lower risk of bleeding complications with a clean operating field and better brain and myocardial oxygenation.
气管袖状切除术治疗肺癌是一种古老的技术，仅保留用于气管隆突受累的特殊情况。该手术的术中气道管理极其复杂，涉及胸外科医生、麻醉师和肺科医生。我们报告了一例 38 岁男性病例，无临床病史，因累及远端气管、隆突和主右支气管的腺样囊性癌而被转诊至我科。使用体外膜氧合 (ECMO) 进行气管袖状切除术。通过超声辅助，在右股静脉和内颈静脉内置入肝素涂层经皮插管建立静脉-静脉 ECMO 回路。未发生重大并发症，患者在 30 天支气管镜检查控制后出院，显示无瘘管且亚甲蓝试验阴性。ECMO 辅助手术可确保充分的呼吸支持、血流动力学稳定、较低的出血并发症风险、清洁的手术视野以及更好的脑和心肌氧合。
