case report||食道肿瘤影响插管怎么办?

来自咽腔或食管上段的活动性肿块或肿瘤会增加气道困难的风险。如果清醒插管不可行,在醒着时用锚定缝线固定肿块是创造手术视野外避免球瓣样上呼吸道梗阻的一种替代方法。

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 参考译文      气管插管前后固定和移动食管肿块      一名患者计划在全身麻醉下切除上食管肿瘤。在食管中发现一个大肿块(14×2×2cm)(图A)。   72761642460646731 肿块可自由反流至口腔(图B)并吞咽回食管。患者否认呼吸或吞咽有明显困难。为了通过支撑喉镜获得手术视图,看到肿块,外科医生要求术中将肿块保留在口中。     32121642460646892 

讨论清醒插管是因为担心诱导后的气道损害,但由于患者拒绝而未进行。相反,在诱导后进行气管插管。 为确保在诱导/插管期间将肿块吞咽入食管,并在插管后将其拉回到口腔进行手术,局麻后在诱导前用缝线固定肿瘤尖端(图C)。 然后,患者被要求吞咽肿瘤,并充分松弛回缩缝线。诱导后,面罩通气有效,直接喉镜显示声门I级。喉镜检查时可以看到回缩缝线,但不能看到肿瘤(图D)。气管插管采用可视喉镜检查。在确认正确放置气管导管后,成功切除肿块。   99281642460647037 

来自咽腔或食管上段的活动性肿块或肿瘤会增加气道困难的风险。如果清醒插管不可行,在醒着时用锚定缝线固定肿块是创造手术视野外避免球瓣样上呼吸道梗阻的一种替代方法。    

原文    Securing and Mobilizing an Esophageal Mass before and after Endotracheal Intubation      A patient was scheduled for upper esophagus tumor resection under general anesthesia. A large mass (14 × 2 × 2 cm) was found in the esophagus (panel A). The mass could be regurgitated freely to the mouth (panel B) and swallowed back into the esophagus. The patient denied significant difficulty breathing or swallowing. To achieve the surgical view with suspension laryngoscopy, the surgeon requested that the mass be kept in the mouth intraoperatively. Awake intubation was discussed because of a concern for airway compromise after induction but not performed due to patient refusal. Instead, tracheal intubation was performed after induction. To ensure the mass was swallowed into the esophagus during induction/intubation and pulled back into the mouth for surgery after intubation, the tip of the tumor was anchored with a suture after topicalization and before induction (panel C). Then the patient was asked to swallow the tumor with adequate slack of the retraction suture. After induction, mask ventilation was effective and direct laryngoscope revealed a grade I view of the glottis. The retraction suture, but not the tumor, was visible during laryngoscopy (panel D). Tracheal intubation was performed with videolaryngoscopy. On confirmation of the correct endotracheal tube placement, the mass was successfully resected. A mobile mass or tumor originating from the pharyngeal cavity or upper segment of the esophagus imposes the risk of a difficult airway. If awake intubation is not feasible, securing the mass with an anchoring suture while awake is an alternative to avoid ball-valve upper airway obstruction, besides creating the surgical view. (图片来自原文)

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