Shu Chen, Bao Peilong, Ni Yunfeng, Lei Jie, Yan Xiaolong, Xie Nianlin, Zhao Jinbo
Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China.
Zhongguo Fei Ai Za Zhi. 2024 Sep 20;27(9):717-724. doi: 10.3779/j.issn.1009-3419.2024.101.22.
Airway management in complex tracheobronchial surgery (TBS) remains a challenge in thoracic surgery. The use of extracorporeal membrane pulmonary oxygenation (ECMO) in thoracic surgery is rather rare, except for lung transplantation. To report the safety and efficacy of ECMO in complex TBS, a total of 5 patients with tracheobronchial and bronchial reconstructive surgery supported by ECMO in the Department of Thoracic Surgery of Tangdu Hospital, Air Force Medical University from May 2019 to June 2024 were collected. Among them, 4 cases of tracheal tumor (including long-segment trachea resection and reconstruction, or carinal resection and reconstruction) and 1 case of acute airway obstruction caused by tracheal rupture were included, all of which were performed in veno-venous ECMO (V-V ECMO) mode. Systemic heparinization was used in 2 patients, and anticoagulation was not performed in 3 patients, which were maintained only by ECMO heparin-coated lines. 4 patients recovered well after surgery, and 1 patient died 1 month after surgery due to immune-related pneumonia. For complex TBS, or in emergency situations (tracheal stenosis with risk of asphyxiation), ECMO can provide adequate support and safeguard. .
在胸外科手术中，复杂气管支气管手术（TBS）的气道管理仍然是一项挑战。除了肺移植外，体外膜肺氧合（ECMO）在胸外科手术中的应用相当罕见。为了报告ECMO在复杂TBS中的安全性和有效性，收集了2019年5月至2024年6月在空军军医大学唐都医院胸外科接受ECMO支持的5例气管支气管和支气管重建手术患者。其中包括4例气管肿瘤（包括长段气管切除重建或隆突切除重建）和1例气管破裂导致的急性气道梗阻，均采用静脉-静脉ECMO（V-V ECMO）模式进行。2例患者采用全身肝素化，3例患者未进行抗凝，仅通过ECMO肝素涂层管路维持。4例患者术后恢复良好，1例患者术后1个月因免疫相关性肺炎死亡。对于复杂的TBS，或在紧急情况下（有窒息风险的气管狭窄），ECMO可以提供充分的支持和保障。
