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一名晚期食管癌致恶性中央气道梗阻的插管患者在呼吸机支持下接受放射治疗：病例报告

Intubated patient of malignant central airway obstruction due to advanced esophageal cancer on ventilator support treated with radiotherapy: a case report.

作者信息

Dokania Shubham, Choubey Ajay K, Tiwari Shashank, Nath Prasenjit, Pattanaik Jhansi, Nanda Sambit S, Mukherji Ashutosh, Pradhan Satyajit

机构信息

Department of Radiation Oncology, Mahamana Pandit MadanMohan Malaviya Cancer Centre, Varanasi 221005, Uttar Pradesh, India.

https://orcid.org/0009-0009-8200-3304.

出版信息

Ecancermedicalscience. 2025 Apr 17;19:1895. doi: 10.3332/ecancer.2025.1895. eCollection 2025.

DOI:10.3332/ecancer.2025.1895
PMID:40496316
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12149233/
Abstract

Malignancies, associated directly or indirectly with airways, can cause a fatal condition, called malignant central airway obstruction (MCAO). Both endoluminal and extraluminal MCAO are conventionally treated using bronchoscopy-mediated therapies, but in patients unsuitable for bronchoscopic interventions, there are very limited options, especially if the patient needs ventilator support due to the obstruction. Few patients of carcinoma lung with MCAO needing ventilator support have been treated using radiotherapy (RT), with appreciable results. Though multiple risks are associated with shifting such patients out of the intensive care unit, these steps had to be carried out when RT was deemed the only possible solution. In this rare case of carcinoma esophagus with MCAO needing ventilator support and treated with RT, we have shown how RT can be used to increase the possibility of extubation of the patient. Hence, respiratory relief and extubation were aimed and achieved with RT in this case.

摘要

与气道直接或间接相关的恶性肿瘤可导致一种致命状况，称为恶性中央气道阻塞（MCAO）。传统上，腔内和腔外MCAO均采用支气管镜介导的疗法进行治疗，但对于不适合支气管镜干预的患者，选择非常有限，尤其是当患者因阻塞需要呼吸机支持时。很少有需要呼吸机支持的肺癌合并MCAO患者接受放射治疗（RT）并取得了显著效果。尽管将此类患者转出重症监护病房存在多种风险，但当RT被认为是唯一可能的解决方案时，仍必须采取这些措施。在这例罕见的需要呼吸机支持并接受RT治疗的食管癌合并MCAO患者中，我们展示了RT如何用于增加患者拔管的可能性。因此，在该病例中，通过RT旨在并实现了呼吸缓解和拔管。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d87/12149233/15583081c3d5/can-19-1895fig7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d87/12149233/01d2754fe9d3/can-19-1895fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d87/12149233/d6bad7f7a170/can-19-1895fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d87/12149233/bdffaf89a6cf/can-19-1895fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d87/12149233/53d25cb46f63/can-19-1895fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d87/12149233/243450312e93/can-19-1895fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d87/12149233/c41cca8575a6/can-19-1895fig6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d87/12149233/15583081c3d5/can-19-1895fig7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d87/12149233/01d2754fe9d3/can-19-1895fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d87/12149233/d6bad7f7a170/can-19-1895fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d87/12149233/bdffaf89a6cf/can-19-1895fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d87/12149233/53d25cb46f63/can-19-1895fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d87/12149233/243450312e93/can-19-1895fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d87/12149233/c41cca8575a6/can-19-1895fig6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d87/12149233/15583081c3d5/can-19-1895fig7.jpg

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本文引用的文献

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Respirology. 2024 Aug;29(8):704-712. doi: 10.1111/resp.14723. Epub 2024 Apr 18.
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Revisiting bronchoscopic intratumoral chemotherapy in malignant central airway obstruction via EUS-B approach and its review of literature.通过超声内镜引导下经支气管途径对恶性中央气道梗阻进行支气管镜瘤内化疗的再探讨及其文献综述
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Esophageal Stricture Following Radiation, Concurrent Immunochemotherapy, Treated With Hyperbaric Oxygen and Dilation.
放疗及同步免疫化疗后食管狭窄，采用高压氧及扩张治疗。
Mayo Clin Proc Innov Qual Outcomes. 2019 May 27;3(2):241-245. doi: 10.1016/j.mayocpiqo.2019.04.002. eCollection 2019 Jun.
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Characteristics and outcome of patients with newly diagnosed advanced or metastatic lung cancer admitted to intensive care units (ICUs).入住重症监护病房（ICU）的新诊断为晚期或转移性肺癌患者的特征及预后。
Ann Intensive Care. 2018 Aug 4;8(1):80. doi: 10.1186/s13613-018-0426-2.
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Risk factors for esophageal fistula in patients with locally advanced esophageal carcinoma receiving chemoradiotherapy.接受放化疗的局部晚期食管癌患者发生食管瘘的危险因素。
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Central Airway Obstruction: Benign Strictures, Tracheobronchomalacia, and Malignancy-related Obstruction.中央气道阻塞：良性狭窄、气管支气管软化症和与恶性肿瘤相关的阻塞。
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