体外循环下切除原发性气管恶性肿瘤的围手术期处理

目的总结体外循环下切除原发性气管恶性肿瘤围手术期的处理经验。方法自1999年12月至2003年8月,6例原发性气管恶性肿瘤患者在体外循环下行肿瘤切除术。2例患者经右股动、静脉插管行急诊手术,4例患者开胸经右心房和升主动脉插管建立体外循环。3例患者行气管环形切除、气管断端行端端吻合;2例患者行气管下段和隆突切除、隆突重建;1例患者行肿瘤剔除术。术前和术后给予雾化吸人,协助咳痰,保持呼吸道通畅。结果术后呼吸困难均有明显好转,呼吸机辅助呼吸10h～7d,全组无手术死亡。结论对于气管严重梗阻的原发性气管恶性肿瘤患者,体外循环下行肿瘤切除是有效的治疗方法,术前和术后保持呼吸道通畅有利于术后恢复。

Perioperative management for primary tracheal malignant tumors resected under cardiopulmonary bypass

OBJECTIVE: To retrospectively review the perioperative management for primary tracheal malignant tumors resected under cardiopulmonary bypass. METHODS: The data of 6 patients with primary tracheal malignant tumors who underwent surgery under cardiopulmonary bypass from December 1999 to August 2003 were reviewed. Cardiopulmonary bypass was established through right femoral vessels in 2 patients for emergency operation, through right atrium and ascending aorta in 4 patients. Sleeve tracheal resections in 3 patients, carinal resections and carina reconstructions in 2, and local enucleation in 1 were performed. Respiratory airway was kept patent by coughing and expectorating sputum. RESULTS: All patients' dyspnea were relieved remarkably. The postoperative mechanic ventilation assistance lasted from 10 hours to 7 days. There was no perioperative mortality. CONCLUSION: Resection of primary tracheal malignant tumors with severe tracheal obstruction under cardiopulmonary bypass is practicable. Keeping respiratory airway patent perioperatively is very important and helpful to postoperative recovery.