气管切除与人工气管重建手术25例麻醉方法分析

Analysis of anesthetic methods for tracheal resection and reconstruction with artificial trachea： a report of 25 cases

目的分析讨论气管切除吻合或人工气管替代等手术的麻醉方式和结果。方法对采用不同手术方式治疗的25例气管良、恶性疾病患者的麻醉和手术过程进行了回顾性分析。其中良性疾病患者10例，恶性疾病患者15例。全组患者气管管腔均有不同程度的狭窄，严重者伴有明显呼吸困难。气管病变长度2．0～7．5cm。气管切除最长者8cm，行一期吻合者14例，行人工气管替代者7例。该组患者采用单纯全身麻醉气管插管者13例，同时行心肺转流者2例；经已有的气管切开行全身麻醉者8例，在局部麻醉下行气管切开后全身麻醉者2例；行高频喷射通气辅助者2例。气管切断后，均需经远端气管或对侧主支气管内插管维持麻醉和通气。结果全组患者均顺利完成手术，无麻醉和手术死亡。2例患者于气管切开后向左主支气管插管困难，1例患者向左主支气管插管过深，仅余左下肺通气，造成血氧饱和度下降；1例患者术毕改换无气囊导管时造成吻合口裂开；均经处理后好转。结论气管手术麻醉风险高，个性化、周密的麻醉和手术方案以及麻醉医师与手术医师的密切配合，是保证麻醉和手术安全的关键。

Objective To analyze and discuss the anesthetic methods and processes for the operations including long-segment resection of the trachea and one-stage anastomosis or reconstruction with artificial trachea. Methods The clinical data of 25 cases from January 1987 to August 2007 with trachea diseases were analyzed retrospectively. There were 10 cases with benign diseases and 15 cases with malignant diseases. All cases represented tracheal stenosis. Some cases represented severe dyspnea. The length of the tracheal lesions was from 2. 5 to 7.5 cm. The longest resection of the trachea was 8. 0 cm. Direct reanastomosis were carried out in 14 cases. Reconstruction with artificial trachea were carried out in 7 cases. Thirteen cases underwent general anesthesia with endotracheal intubation only, while 2 cases were assisted with artificial cardiopulmonary bypass. Eight cases were intubated via existed tracheotomy. Two cases received bedside tracheotomy with local anesthesia. Two cases were assisted with high frequency jet ventilation. During the operation, a tube was inserted into the distal trachea or contralateral main bronchus to maintain anesthesia and ventilation after the trachea resection. Results All of the 25 patients had good outcome. There was no death caused by anesthesia or operation. However, transient lower SaOa was found in 2 cases because of the difficult intubation of left main bronchus after the resection of the trachea. One case was ventilated with only lower lobe because of the extra-deep intubation of the left main bronchus. Anastomosis dehiscence happened in 1 case when the non-balloon trachea tube was used immediately after the operation. Conclusions The mortality of anesthesia for tracheal operation are quite high. Therefore, individual treatment with carefully-designed anesthetic and operative protocol, and good communications and cooperation between anesthesiologists and surgeons is the key factor for the success of anesthesia and operation.