体外膜肺氧合在复杂气管支气管手术中的应用:系列病例报道和文献综述  

Extracorporeal Membrane Oxygenation in Complex Tracheobronchial Surgery:A Series Case Reports and Systematic Review

作　　者：束晨 鲍培龙 倪云峰 雷杰 闫小龙 谢念林 赵晋波 Chen SHU;Peilong BAO;Yunfeng NI;Jie LEI;Xiaolong YAN;Nianlin XIE;Jinbo ZHAO(Department of Thoracic Surgery,Tangdu Hospital,Air Force Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学唐都医院胸腔外科,西安710038

出　　处：《中国肺癌杂志》2024年第9期717-724,共8页Chinese Journal of Lung Cancer

基　　金：国家自然科学基金项目(No.82070101);军队高层次科技创新人才工程自主科研项目(No.2024)。

摘　　要：复杂气管支气管手术(tracheobronchial surgery,TBS)的气道管理仍然是胸外科手术中的难点。除肺移植手术之外,体外膜肺氧合技术(extracorporeal membrane pulmonary oxygenation,ECMO)在胸外科手术中应用较少。为了探究ECMO在复杂TBS中的安全性和有效性,本研究收集了2019年5月至2024年6月空军军医大学唐都医院胸腔外科在ECMO支持下的复杂气管、支气管重建手术患者共5例,其中气管肿瘤4例(长段气管切除重建或隆突切除重建),气管断裂导致气道急性梗阻1例。5例患者全部采用静脉到静脉ECMO(veno-venous ECMO,V-V ECMO)模式,2例患者采用了全身肝素化,3例患者未进行全身肝素化,仅通过ECMO肝素涂层管路维持。术后4例患者恢复良好,1例患者因免疫相关性肺炎于术后1个月死亡。对于复杂TBS(长段气管切除、气管断裂导致气道急性梗阻或隆突切除重建),或在紧急状况下(气管狭窄,存在窒息风险),ECMO能够提供较好的支持和保障。Airway management in complex tracheobronchial surgery(TBS)remains a challenge in thoracic surgery.The use of extracorporeal membrane pulmonary oxygenation(ECMO)in thoracic surgery is rather rare,except for lung transplantation.To report the safety and efficacy of ECMO in complex TBS,a total of 5 patients with tracheobronchial and bronchial reconstructive surgery supported by ECMO in the Department of Thoracic Surgery of Tangdu Hospital,Air Force Medical University from May 2019 to June 2024 were collected.Among them,4 cases of tracheal tumor(including longsegment trachea resection and reconstruction,or carinal resection and reconstruction)and 1 case of acute airway obstruction caused by tracheal rupture were included,all of which were performed in veno-venous ECMO(V-V ECMO)mode.Systemic heparinization was used in 2 patients,and anticoagulation was not performed in 3 patients,which were maintained only by ECMO heparin-coated lines.4 patients recovered well after surgery,and 1 patient died 1 month after surgery due to immunerelated pneumonia.For complex TBS,or in emergency situations(tracheal stenosis with risk of asphyxiation),ECMO can provide adequate support and safeguard.

关 键 词：体外膜肺氧合技术 气管支气管 气道手术 

分 类 号：R614[医药卫生—麻醉学]