CAJ | 학술논문

目的分析讨论气管切除吻合或人工气管替代等手术的麻醉方式和结果.方法对采用不同手术方式治疗的25例气管良、恶性疾病患者的麻醉和手术过程进行了回顾性分析.其中良性疾病患者10例,恶性疾病患者15例.全组患者气管管腔均有不同程度的狭窄,严重者伴有明显呼吸困难.气管病变长度2.0～7.5cm.气管切除最长者8 cm,行一期吻合者14例,行人工气管替代者7例.该组患者采用单纯全身麻醉气管插管者13例,同时行心肺转流者2例;经已有的气管切开行全身麻醉者8例,在局部麻醉下行气管切开后全身麻醉者2例;行高频喷射通气辅助者2例.气管切断后,均需经远端气管或对侧主支气管内插管维持麻醉和通气.结果全组患者均顺利完成手术,无麻醉和手术死亡.2例患者于气管切开后向左主支气管插管困难,1例患者向左主支气管插管过深,仅余左下肺通气,造成血氧饱和度下降;1例患者术毕改换无气囊导管时造成吻合口裂开;均经处理后好转.结论气管手术麻醉风险高,个性化、周密的麻醉和手术方案以及麻醉医师与手术医师的密切配合,是保证麻醉和手术安全的关键.
목적 분석토론기관절제문합혹인공기관체대등수술적마취방식화결과.방법 대채용불동수술방식치료적25례기관량、악성질병환자적마취화수술과정진행료회고성분석.기중량성질병환자10례,악성질병환자15례.전조환자기관관강균유불동정도적협착,엄중자반유명현호흡곤난.기관병변장도2.0～7.5cm.기관절제최장자8 cm,행일기문합자14례,행인공기관체대자7례.해조환자채용단순전신마취기관삽관자13례,동시행심폐전류자2례;경이유적기관절개행전신마취자8례,재국부마취하행기관절개후전신마취자2례;행고빈분사통기보조자2례.기관절단후,균수경원단기관혹대측주지기관내삽관유지마취화통기.결과 전조환자균순리완성수술,무마취화수술사망.2례환자우기관절개후향좌주지기관삽관곤난,1례환자향좌주지기관삽관과심,부여좌하폐통기,조성혈양포화도하강;1례환자술필개환무기낭도관시조성문합구렬개;균경처리후호전.결론 기관수술마취풍험고,개성화、주밀적마취화수술방안이급마취의사여수술의사적밀절배합,시보증마취화수술안전적관건.
Objective To analyze and discuss the anesthetic methods and processes for the operations including long-segment resection of the trachea and one-stage anastomosis or reconstruction with artificial trachea.Methods The clinical data of 25 cases from January 1987 to August 2007 with trachea diseases were analyzed retrospectively.There were 10 cases with benign diseases and 15 cases with malignant diseases.All cases represented tracheal stenosis.Some cases represented severe dyspnea.The length of the tracheal lesions was from 2.5 to 7.5 cm.The longest resection of the trachea was 8.0 cm.Direct reanastomosis were carried out in 14 cases.Reconstruction with artificial trachea were carried out in 7 cases.Thirteen cases underwent general anesthesia with endotracheal intubation only,while 2 cases were assisted with artificial cardiopulmonary bypass.Eight cases were intubated via existed tracheotomy.Two cases received bedside tracheotomy with local anesthesia.Two cases were assisted with high frequency jet ventilation.During the operation,a tube was inserted into the distal trachea or contralateral main bronchus to maintain anesthesia and ventilation after the trachea resection.Results All of the 25 patients had good outcome.There was no death caused by anesthesia or operation.However,transient lower SaO2 was found in 2 cases because of the difficult intubation of left main bronchus after the resection of the trachea.One case was ventilated with only lower lobe because of the extra-deep intubation of the left main bronchus.Anastomosis dehiscence happened in 1 case when the non-balloon trachea tube was used immediately after the operation.Conclusions The mortality of anesthesia for tracheal operation are quite high.Therefore,individual treatment with carefully-designed anesthetic and operative protocol,and good communications and cooperation between anesthesiologists and surgeons is the key factor for the success of anesthesia and operation.