气管狭窄手术麻醉插管与手术方式的特点分析  

Analysis of the characteristics of intubation under anesthesia and surgery methods in patients with tracheal stenosis

作　　者：严光兵 戴天阳 刘玉林 何开明 韩飞 蒲江涛 曾培元 王超 Guang-bin Yan;Tian-yang Dai;Yu-lin Liu;Kai-ming He;Fei Han;Jiang-tao Pu;Pei-yuan Zeng;ChaoWang(Department of Thoracic Surgery,Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,China;Department of Anesthesia,Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,China)

机构地区：[1]西南医科大学附属医院胸外科,四川泸州646000 [2]西南医科大学附属医院麻醉科,四川泸州646000

出　　处：《中国现代医学杂志》2021年第14期74-78,共5页China Journal of Modern Medicine

摘　　要：目的探讨在气管狭窄的外科治疗中如何正确选择麻醉插管方式与手术方式。方法选取1998年1月—2018年12月在西南医科大学附属医院胸外科手术治疗的32例气管狭窄患者的临床资料,按不同致气管狭窄原因分为肿瘤组、非肿瘤组。比较两组患者临床资料的差异。记录并比较两组患者麻醉插管方式、手术方式、手术时间、手术出血量、术后插管时间、术后住院日及术后并发症等情况。随访1个月~20年,统计分析两组气管吻合口狭窄发生率、疾病复发率等指标。结果肿瘤组气管修补术较非肿瘤组低(P<0.05),气管环形切除+端端吻合及单腔插管+全麻较非肿瘤组高(P<0.05)。两组手术切口比较,差异无统计学意义(P>0.05)。两组中、下段气管狭窄的麻醉方式和手术方式比较,差异无统计学意义(P>0.05)。肿瘤组手术时间、术中出血量较非肿瘤组高(P<0.05)。两组术后并发症比较,差异无统计学意义(P>0.05)。患者均治愈出院,两组患者均未发生手术及围手术期死亡。结论气管狭窄往往是亚急诊或急诊性病种,手术治疗是最有效的方法。麻醉插管及手术方式应依据气管狭窄的特点而灵活选择,若能正确选择,将有效提高气管狭窄手术成功率。Objective To explore how to choose the methods of intubation under anesthesia and surgery in the treatment of tracheal stenosis.Methods The clinical data of 32 patients with tracheal stenosis treated by thoracic surgery in our hospital from January 1998 to December 2018 were collected and divided into tumor group and non tumor group according to the causes of tracheal stenosis.The methods of intubation and surgery,operative duration,intraoperative bleeding volume,postoperative intubation time,postoperative hospital stay and postoperative complications were recorded and compared between the two groups.The duration of follow-up ranged from 1 month to 20 years,and the incidence of tracheal anastomotic stenosis and the recurrence rate of the two groups were analyzed.Results The proportion of repair of tracheal defects was lower in the tumor group,while that of circumferential tracheal resection with end-to-end anastomosis and repair of tracheal defects was higher in the tumor group(P<0.05),with no difference in surgical incision(P>0.05).The methods of intubation and surgery for tracheal stenosis in the middle and lower segments were not different between the two groups(P>0.05).The operative duration and intraoperative bleeding volume in the tumor group were higher than those in the non-tumor group(P<0.05).Besides,the incidence of postoperative complications did not differ between the two groups(P>0.05).Conclusions Tracheal stenosis is often a sub-emergency or emergency condition,and surgical treatment is the most effective way to deal with it.According to the characteristics of tracheal stenosis,we can choose the methods of intubation and surgery flexibly to increase the success rate of management of tracheal stenosis.

关 键 词：气管狭窄 插管法 气管内 麻醉 

分 类 号：R562.12[医药卫生—呼吸系统]