Li Yinjun, Jiang Yu, Su Zixuan, Liang Hengrui, He Jianxing, Li Shuben
Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
State Key Laboratory of Respiratory Disease, Guangzhou, China.
Ann Transl Med. 2021 Aug;9(15):1265. doi: 10.21037/atm-21-1786.
Extramedullary plasmacytoma (EMP) is an uncommon monoclonal plasma cell malignancy that arises outside of the bone marrow. Rarely, EMPs can occur in the trachea, resulting in severe respiratory distress. Due to a small number of cases, the optimal management of tracheal EMP remains a topic of debate. Here, we report a rare case of solitary tracheal EMP causing symptoms of cough, sputum, paroxysmal nocturnal dyspnea, and progressive exertional dyspnea in a 65-year-old male patient. Computerized tomography and fibro bronchoscopy indicated a pedicled nodular mass on the anterior tracheal wall obstructing over 95% of the lumen. The patient was soon successfully managed with partial tracheal resection and reconstruction surgery under non-intubated anesthesia and was diagnosed as EMP by histopathology of the resected mass. Additional laboratory tests excluded the diagnosis of multiple myeloma (MM). There are no signs of recurrence after 6 months of follow-up. Although traditional intubated anesthesia with single-lung mechanical ventilation has been widely applied to radical surgery for tracheal tumors, it is associated with a higher incidence of intubation-related complications and thus prolongs the surgical procedure and postoperative recovery. In this article, we reported the application of tracheal resection and reconstruction under non-intubated anesthesia for the treatment of tracheal EMP, which was proved to be feasible and safe. Non-intubated anesthesia for tracheal resection and reconstruction is likely to be an alternative minimally invasive option for patients with tracheal EMP involving central airways.
髓外浆细胞瘤（EMP）是一种罕见的单克隆浆细胞恶性肿瘤，发生于骨髓外。EMP很少发生在气管，可导致严重的呼吸窘迫。由于病例数量较少，气管EMP的最佳治疗方案仍是一个有争议的话题。在此，我们报告一例罕见的孤立性气管EMP病例，该病例导致一名65岁男性患者出现咳嗽、咳痰、阵发性夜间呼吸困难和进行性劳力性呼吸困难等症状。计算机断层扫描和纤维支气管镜检查显示气管前壁有一个带蒂的结节状肿块，阻塞管腔超过95%。该患者很快在非插管麻醉下成功接受了部分气管切除重建手术，并通过切除肿块的组织病理学检查确诊为EMP。进一步的实验室检查排除了多发性骨髓瘤（MM）的诊断。随访6个月后无复发迹象。尽管传统的单肺机械通气插管麻醉已广泛应用于气管肿瘤根治手术，但它与插管相关并发症的发生率较高相关，从而延长了手术过程和术后恢复时间。在本文中，我们报告了非插管麻醉下气管切除重建术在气管EMP治疗中的应用，事实证明该方法可行且安全。对于累及中央气道的气管EMP患者，非插管麻醉下的气管切除重建术可能是一种替代性的微创选择。
