肿瘤性颈段气管狭窄致呼吸困难的急诊气道开放方法探讨  

Exploration of emergency airway opening method for dyspnea caused by tumor related cervical tracheal stenosis

作　　者：吴静[1] 廖妍飞 刘业海[1] WU Jing;LIAO Yanfei;LIU Yehai(Department of Otolaryngology Head and Neck Surgery,First Affiliated Hospital of Anhui Medical University,Hefei,Anhui,230000,China)

机构地区：[1]安徽医科大学第一附属医院耳鼻咽喉头颈外科,安徽合肥230000

出　　处：《中国耳鼻咽喉头颈外科》2025年第2期121-124,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：安徽医科大学校科研基金(2023xkj146);安徽省自然科学基金(2408085MH201)。

摘　　要：目的 探讨肿瘤性颈段气管狭窄导致的呼吸困难患者的急诊气道开放方法,总结此类患者安全有效的急诊处理方法。方法 回顾性收集2012年1月~2023年12月于安徽医科大学第一附属医院救治的因肿瘤侵犯或包绕颈段气管导致的呼吸困难急诊入院患者病例资料,分析急诊气道开放的流程或方法,总结此类患者安全有效的气道开放策略。结果 共收集病例31例,其中甲状腺恶性肿瘤侵犯颈段气管25例(分化型甲状腺癌18例,甲状腺淋巴瘤5例,未分化癌1例,髓样癌1例),喉癌术后颈段气管复发3例,颈段气管原发性肿瘤2例,颈段食管癌1例,入院时Ⅱ度呼吸困难24例,Ⅲ度呼吸困难6例,Ⅳ度呼吸困难1例。具体的气道开放方法:6号以下麻醉插管全麻后切除肿瘤后行气管切开20例,以喉为标志行气管前壁纵行向下裂开气管开放气道6例,以颏及胸骨上窝为标志中线切除中线部分肿瘤从而暴露气管后纵行裂开气管前壁2例,急诊体外膜肺(ECMO)支持下气管切开2例,体外循环机支持下气管切开1例,所有患者均成功开放气道,无大出血、窒息、心脑血管意外等严重并发症。结论 常规方法难以暴露气管的肿瘤性颈段气管狭窄需急诊开放气道的患者,可先由麻醉科评估能否插小号气管插管行全麻后行气管切开术,若麻醉科难以插管,可以采取以喉为标志,纵行裂开环状软骨或气管前壁开放气道,若喉体被肿瘤覆盖或包裹,无法暴露者也可采取以颏和胸骨上窝为标志中线,切除中线部分肿瘤暴露气管后纵行裂开气管前壁开放气道。若上述方法均难以操作,可行体外循环或ECMO支持下全麻后切除肿瘤,暴露气管后开放气道。OBJECTIVE To explore emergency airway opening methods for patients with dyspnea caused by tumor related cervical tracheal stenosis,and summarize safe and effective emergency management methods for such patients.METHODS Retrospectively collect cases of dyspnea caused by tumor invasion or wrapping around the cervical trachea treated in the First Affiliated Hospital of Anhui Medical University between January 2012 and December 2023,analyze the process or method of emergency airway opening,and summarize the safe and effective airway opening methods for such patients.RESULTS A total of 31 cases were collected,including 25 cases of thyroid malignant tumors invading the cervical trachea(18 cases of differentiated thyroid cancer,5 cases of thyroid lymphoma,1 case of undifferentiated cancer,and 1 case of medullary cancer),3 cases of cervical tracheal recurrence after laryngeal cancer surgery,2 cases of primary tumors in the cervical trachea,1 case of cervical esophageal cancer,24 cases of grade II dyspnea upon admission,6 cases of grade III dyspnea,and 1 case of grade IV dyspnea.The methods of airway opening are as follows:20 cases underwent tumor resection and tracheotomy under anesthesia intubation and general anesthesia,6 cases underwent longitudinal downward tracheostomy with the larynx as the landmark,2 cases underwent midline tumor resection with the chin and sternum as the landmark to expose the trachea,2 cases underwent emergency tracheotomy with extracorporeal membrane oxygenation(ECMO)support,and 1 case underwent tracheotomy with extracorporeal circulation machine support.All patients successfully opened their airways without serious complications such as major bleeding,asphyxia,or cardiovascular and cerebrovascular accidents.CONCLUSION For patients with tumor induced cervical tracheal stenosis that is difficult to expose the trachea using conventional methods and requires emergency airway opening,the anesthesiology department can first evaluate whether a small tracheal tube can be inserted for general anesthesi

关 键 词：呼吸困难 气管切开术 急诊处理 气管狭窄 肿瘤性 

分 类 号：R730.5[医药卫生—肿瘤]