无症状型会厌囊肿围手术期气道管理

背景 术前对困难气道的准确评估,使麻醉医师对患者气道的管理愈加合理及安全.无症状型会厌囊肿会引起难以预测的紧急困难气道,在全身麻醉快速诱导中易导致通气不畅或插管困难,威胁患者生命安全. 目的 讨论这种突发情况的围手术期气道处理,提高对该病的认识,并为临床提供借鉴. 内容 参考国内外无症状型会厌囊肿病例,收集整理近期困难气道的管理方法,完善无症状型会厌囊肿气道处理流程. 趋向 麻醉医师应迅速对患者的紧急情况进行判断,并选择最佳气道管理方案.     

Adult vallecular cyst: thirteen-year experience.

OBJECTIVE: To assess the characteristics of adult vallecular cyst. STUDY DESIGN AND SETTINGS: A retrospective chart review from a university affiliated hospital. SUBJECTS AND METHODS: Clinical manifestations and airway management of 38 consecutive adult patients with vallecular cyst admitted between 1992 and 2004 were studied. RESULTS: Two distinct groups were identified: infected (n = 24) and noninfected (n = 14). Twenty-two (91.7%) patients of the former group had acute epiglottitis with an abrupt onset culminating in abscess formation in 19 (79.2%) and airway compromise in 9 (37.5%) compared with none in the noninfected group (P = 0.006). In 4 (18.2%) of 22 patients, the origin of the infected vallecular cyst was evident only after symptoms subsided. Three patients had recurrent acute epiglottitis. The noninfected group had a relatively prolonged mild clinical course. CONCLUSIONS: Two types of vallecular cysts were characterized. Abscess formation was the hallmark of adult infected vallecular cyst. SIGNIFICANCE: To improve patient care, endoscopic follow-up is advocated. In patients with recurrent episodes of acute epiglottitis, imaging is recommended.     

Prenatal percutaneous needle drainage of cystic sacrococcygeal teratomas.

Prenatal ultrasound (US) permits in utero diagnosis of sacrococcygeal teratoma (SCT), follow-up of tumor size, and the early identification of complications, allowing for a more timely and appropriate delivery. The recommended management of large SCTs is delivery by cesarean section (CS) to prevent dystocia, tumor rupture, hemorrhage, and death. However, even delivery by CS can be difficult, necessitating a large hysterotomy that adds to maternal morbidity. The authors report two cases of cystic SCTs in which prenatal percutaneous drainage allowed for an uncomplicated vaginal delivery. In the first case, a large unilocular cystic SCT was diagnosed at 31 weeks' gestation on prenatal US. The fetal presentation was breech, and the mass was steadily increasing in size, preventing spontaneous version. At 37 5/7 weeks, the cyst was percutaneously drained under US guidance allowing for successful external version. Repeat drainage just before induction of labor permitted a successful vaginal delivery. In the second case, the cystic SCT was percutaneously drained just before induction of labor at full term, again allowing for an uncomplicated vaginal delivery. Prenatal percutaneous needle drainage of cystic SCTs offers an alternative to CS that results in decreased risks for both mother and fetus.     

Asymptomatic vallecular cyst: airway management considerations

Airway problems are easiest to manage when they are anticipated. Difficult intubation might, however, occur in patients with no obvious signs or symptoms suggesting airway difficulty. We describe a case where laryngeal inlet was obscured by a large vallecular cyst that was discovered during rapid-sequence induction of general anesthesia, causing difficulty in tracheal intubation. Once the patient was allowed to recover from general anesthesia, the trachea could be safely intubated using a fiberoptic bronchoscope.     

Vallecular cyst and laryngomalacia in infants: report of six cases and airway management

IMPLICATIONS: This report describes difficulties encountered in the airway management of six infants with concurrent vallecular cyst and laryngomalacia. It is hoped that our experience will assist others in the management of such patients.     

Anesthetic management of the exit (ex utero intrapartum treatment) procedure

The EXIT (ex utero intrapartum treatment) procedure is used to maintain fetal-placental circulation during partial delivery of a fetus with a potentially life-threatening upper airway obstruction. We performed the EXIT procedure on a fetus with a large intra-oral cyst. Sevoflurane was used as the anesthetic because of its rapid titratability. Sevoflurane provided excellent maternal and fetal anesthesia. Modifications to previously described monitoring techniques for the EXIT procedure were also used.     

Transoral robotic resection of a lingual thyroglossal duct cyst

Thyroglossal duct cysts (TGDCs) are epithelial rests of the thyroid gland left during embryologic descent from the tongue base. Thyroglossal duct cysts confined to the tongue base alone are even more unusual. We present a case of a 45-year-old woman who presented with complaints of sore throat, globus, and throat clearing for 10?years. On examination she was found to have a 2?×?1.5-cm cystic-appearing mass, left of midline in the vallecula. The patient had a transoral robotic resection of this vallecular cyst, which was subsequently found to be a lingual TGDC. We believe this is the first reported case of a TGDC that was successfully excised using a transoral robotic approach.     

Prenatal ultrasonography and early surgery for congenital cystic disease of the lung.

With the recent advent of prenatal ultrasound as a routine screening procedure, diagnosis of congenital cystic lung disease has been made in utero, raising the possibility of elective surgery for these lesions early in infancy before the patient develops respiratory distress or potentially life-threatening infection. From 1979 to 1989 six cases of congenital lung cyst were diagnosed in utero by prenatal ultrasound and followed during pregnancy. Two of the six were not confirmed after birth because the mothers preferred an abortion. The remaining four cases were studied periodically during gestation by ultrasonography. At birth, the first infant developed respiratory distress and underwent urgent left upper lobectomy and left lower segmentectomy at age 18 hours. The other three underwent elective lobectomy at age 10 days, 3 months, and 7 months, respectively. The fourth infant had a normal chest x-ray and ultrasound at birth, and the congenital cysts were confirmed by computed tomography scan. The pathological diagnosis in all four cases was cystic adenomatoid malformation. In two cases, intraoperative measurement of pulmonary function demonstrated significant improvement after resection of the affected lobe. We conclude that congenital lung cysts can be accurately diagnosed by prenatal ultrasound "screening" as early as 18 to 24 weeks' gestation. Advantages of early diagnosis include the option of moving the mother and unborn child to a high-risk obstetrical center for urgent operation on the newborn infant if necessary. Otherwise, once the diagnosis is confirmed, surgical correction can be performed electively and safely before respiratory distress or pulmonary infection complicates the infant's growth and development.     

Prenatal diagnosis of a large, cervical, intraspinal, neurenteric cyst and postnatal outcome

Neurenteric cysts are rare congenital anomalies derived from the notochord and located in front of the spinal column, mostly at the cervical level. They consist of an intraspinal cystic component that is connected to a mediastinal or thoracic cyst. A case of a cervical, intraspinal, neurenteric cyst, diagnosed at 28 weeks of gestation and operated on at 3 and half months after birth, is reported. Herein, we discuss important features of this case including its rare occurrence, intrauterine diagnosis, and early surgical intervention. In conclusion, the nature of prenatal intradural cysts should be fully evaluated and differentiated between neurenteric cyst and other types of cysts with fetal ultrasonography. Therefore, it is essential to be aware of this potential cyst in fetal ultrasonography in utero. Neurenteric cyst should be considered in the differential diagnosis of cervical intradural cystic lesions. In infants, successful surgery provides a cure in patients with cervical neurenteric cysts.     

Laparoscopic diagnosis and management of ovarian torsion in the newborn.

BACKGROUND AND OBJECTIVES: The application of laparoscopic techniques in the surgical management of neonatal ovarian cysts is proving valuable both as a diagnostic tool and a potential therapeutic intervention. We report the successful management of a prenatally diagnosed ovarian cyst in a newborn female and provide operative evidence for the presumptive etiology of the cyst. METHODS AND RESULTS: A prenatally diagnosed ovarian cyst was managed using 5 mm laparoscopic instruments in a newborn female. The prenatal ultrasonographic and operative findings are consistent with in utero adnexal torsion with subsequent autoamputation and cystic degeneration of the ovary. The orphaned ovarian cyst was removed from the infant's abdominal cavity by enlarging the camera port incision. DISCUSSION: The application of laparoendoscopic procedures in infants and children continues to evolve with the availability, of microinstrumentation and increasing experience among pediatric surgeons. This approach may prove valuable in the diagnosis and management of prenatally diagnosed ovarian cysts. In addition, further insight into the etiology of congenital ovarian cysts may be obtained. The safety and efficacy of this approach in these infants remains to be fully evaluated.     

Antenatal detection of developing nervous system abnormalities and perinatal surgical management

As the use of prenatal ultrasound sonographic study becomes more popular, it is likely that several fetal anomalies of the central nervous system will be diagnosed in utero more frequently and accurately. Obstetric sonogram correlates well with the results of postnatal CT scanning. Now, with improved diagnosis and support facilities for the newborn, neurosurgical intervention is being requested, as more concern is expressed for such fetus. We have experienced seven cases of fetal disorders of the central nervous system-meningocele, meningoencephalocele, myeloschisis, arachnoid cyst and maximal hydrocephalus. When diagnosed late in gestation (after the 2nd trimester), it may be reasonable to consider early delivery at the time of pulmonary maturity, and extrauterine management to decrease secondary damage to the developing central nervous system. The method of delivering a fetus must be tailored to suit each case. We present our program for the management of fetal hydrocephalus-placement of a subcutaneous low profile Ommaya's reservoir for neonate immediately after birth, and then subsequently conversion to a ventriculoperitoneal shunt three or four weeks later. As advances are made in antenatal diagnostic techniques and appropriate therapy, prognostic data on congenital abnormalities of the central nervous system will increase and become more pertinent.     

Simulation of posterior fossa cyst by normal, hypo-echoic white matter on cranial ultrasonography

Ultrasonography in the diagnosis of fetal abnormalities is well documented, and improvements in technology have made possible detailed visualization of the intracranial anatomy. Ten per cent of major fetal abnormalities involve the head and neck. A case of simulation of a posterior fossa cyst by normal, hypoechoic white matter on cranial ultrasonography is presented. Potential pitfalls and the differential diagnosis of intracranial abnormalities in utero are discussed.     

Congenital lingual cysts

Congenital lingual cysts are rare congenital tumors of the oropharynx, which should be suspected when the tongue appears enlarged by a mass. Prenatal diagnosis by ultrasound allows for an optimal management at the time of delivery because the mass can obstruct the airways. Unless the cyst enlarges and hinders feeding or breathing, surgical treatment is indicated only a few months after birth because spontaneous regression can sometimes be observed.     

肾盏憩室伴感染合并妊娠1例报告并文献分析

目的：探讨肾盏憩室伴感染合并妊娠的临床特点及诊治方法。方法：回顾性分析1例肾盏憩室伴感染合并妊娠患者的临床资料：患者经抗感染、B超定位穿刺引流、留置单J管治疗等以控制感染;观察穿刺引流量及囊液分析,明确诊断为肾盏憩室;分娩后2个月行肾盏憩室去顶＋憩室颈口缝合术。结果：患者随访半年,肾盏憩室消失。结论：肾盏憩室伴感染合并妊娠临床少见,易误诊。妊娠期行囊肿穿刺引流并留置单J管安全有效。观察引流量及囊液分析有利于明确诊断。分娩后行手术治疗。肾盏憩室,效果确切。     

Pseudotumoral hydatid cyst of chest wall

Hydatid disease is a zoonotic infection caused by Echinoccosis granulosus and our country was an endemic area. Osseous localization is uncommon and can be confused with tumor. We present a case of a hydatid cyst with rib involvement in a 57-year-old man presented with thoracic pain and swelling mimicking chest wall tumor. We confirmed diagnosis only by surgical exploration and histopathology exam because radiology is not conclusive. Surgery remains the first choice for treatment in hydatid cyst disease that can remove the parasite radically. However, in osseous localization pre and postoperative course of albendazole for 6?months associated with surgery can help in sterilizing the cyst and reduce the recurrence rate. Hydatid cyst can involve all the thoracic structures; rib localization is rare and needs surgical resection for total eradication.     

A persistent 'can't intubate, can't oxygenate' crisis despite rocuronium reversal with sugammadex

A 'can't intubate, can't oxygenate' airway crisis is a rare event which most anaesthetists will never experience during their career(1,2). This report highlights the outcome of time-critical decisions in a potential airway catastrophe. Rocuronium was used as an alternative muscle relaxant for rapid sequence induction. The use of sugammadex in 'can't intubate, can't oxygenate' crises is discussed and highlights how, despite adequate reversal of neuromuscular blockade, the 'can't intubate, can't oxygenate' situation failed to resolve. An asymptomatic vallecular cyst was the causal factor in this scenario. Anaesthetic issues surrounding this pathology are discussed.     

Fetal therapy for giant hepatic cysts

Cystic mesenchymal hamartoma is an extremely rare, benign tumor. Rapid growth to a giant size can pose a threat not only in early childhood but also during fetal life. The experience with 2 antenatally diagnosed giant hepatic cysts with widely disparate approaches to management, treatment, and outcome is presented. A giant hepatic cyst was diagnosed on routine screening ultrasound scan. Because of its extremely massive size, the cyst was treated in utero with repeated aspirations, primarily for obstetric considerations. The infant did well, and the lesion was excised laparoscopically during the neonatal period. A second fetus with a giant hepatic cyst was not treated in utero, and the pregnancy continued to term. Nonimmune hydrops fetalis developed, and the fetus was delivered prematurely at 34 weeks. At birth, the infant was noted to have diffuse neurologic injury and no urine output despite normal-appearing kidneys. The lesion was excised during the neonatal period by open laparotomy. Observations at the time of surgery and pathologic studies of the placenta showed aneurysmal dilatation of the placental veins suggesting in utero compression of the fetal intraabdominal umbilical vein. The infant died shortly after birth. The experience with these 2 cases suggests the possibility that giant mesenchymal hamartoma diagnosed in utero may cause umbilical venous obstruction leading to ischemia during fetal life. Decompression of giant hepatic cysts may reverse this phenomenon and allow normal fetal development. J Pediatr Surg 37:E31.     

Simple cysts of the testis in children: preoperative diagnosis by ultrasound and excision with testicular preservation

We report on 2 children with simple cysts of the testis who were treated with excision and testicular preservation. To our knowledge both cases represent the first report of conservative surgery for these lesions in children. In 1 case the diagnosis of a simple intratesticular cyst was made by ultrasound. This patient was followed conservatively until enlargement resulted in excision of the cyst with preservation of the gonad. In the other case the diagnosis was made intraoperatively and simple excision of the lesion with testicular sparing was performed. High resolution real-time ultrasound should be performed routinely for all suspected testicular masses in children. Benign testicular tumors are more common than in adults and ultrasound may permit identification of lesions that can be excised locally with testicular preservation. Should the diagnosis of a simple, small intratesticular cyst be made by ultrasound regular followup may be appropriate. Should enlargement occur surgical excision can be done with the possibility of gonadal preservation.     

Unusual brain edema caused by an intracranial hydatid cyst: c ase report and literature review

The differential diagnosis of intracranial brain cystic lesions, including malignant lesions, abscesses and cystic astrocytoma, can sometimes be difficult even when using a sophisticated imaging technique. This is particularly evident in certain rare lesions such as hydatid cysts. In fact, any imaging modality that can make the diagnosis can optimize conservative or surgical treatment and prevent unnecessary biopsy. A case of a six-year-old male with raised intracranial tension and rapid consciousness disturbance presumably caused by a left frontal hydatid cyst, surrounded by an unusual edema is reported. We concluded that intracranial hydatid cyst should be entertained whenever a cystic lesion is found in an endemic region.     

Pitfall in renal cyst surgery: serous cystadenoma of pancreas mimicking renal cyst

Pancreatic lesions, particularly cysts, can simulate various diseases. We report a case of a 43-year-old woman with a large, symptomatic, retroperitoneal cyst misdiagnosed as a "renal cyst." During the retroperitoneoscopic marsupialization, the correct diagnosis of a pancreatic cyst was made, leading to an open pancreas tail resection. Histologic evaluation revealed serous cystadenoma. Especially in large retroperitoneal cysts on the left side, the correct diagnosis of a pancreatic cyst can be difficult.