Geiduschek J M, Inglis A F, O'Rourke P P, Kozak F K, Mayock D E, Sawin R S
Department of Anesthesiology, University of Washington School of Medicine, Seattle.
Ann Otol Rhinol Laryngol. 1993 Nov;102(11):827-33. doi: 10.1177/000348949310201101.
Few survivors have been reported following attempted repair of laryngotracheoesophageal clefts (LTECs). The major challenge is maintaining oxygenation, both during the surgical repair and during the postoperative period of healing. We report a neonate with an LTEC extending to the carina whose successful repair was facilitated by extracorporeal membrane oxygenation (ECMO) begun intraoperatively and continued postoperatively for 11 days. The intraoperative surgical exposure of the defect was excellent. Postoperative trauma to the fresh tracheal repair from ventilatory pressures and endotracheal tube motion was eliminated through the use of ECMO. The patient was discharged without a tracheotomy and with a normal voice, cry, and swallow. According to this result, the use of ECMO may represent a significant advance in facilitating the correction of major laryngotracheoesophageal anomalies. The rationale, advantages, disadvantages, and potential pitfalls of this approach are presented, as well as preoperative and postoperative documentation of our results.
据报道，喉气管食管裂（LTEC）修复术的幸存者寥寥无几。主要挑战在于手术修复期间及术后愈合阶段维持氧合。我们报告了一名LTEC延伸至隆突的新生儿，术中开始并术后持续使用体外膜肺氧合（ECMO）11天，成功完成了修复。术中对缺损的手术显露极佳。通过使用ECMO，消除了通气压力和气管内导管移动对新鲜气管修复造成的术后创伤。患者出院时未行气管切开术，声音、哭声和吞咽功能正常。根据这一结果，ECMO的使用可能代表了在促进纠正主要喉气管食管畸形方面的一项重大进展。本文介绍了这种方法的原理、优点、缺点和潜在风险，以及我们术前和术后的结果记录。
