气管或隆凸部肿瘤患者围手术期呼吸问题的处理

Management of perioperative respiratory problems in patients with tumor of trachea or carina

目的 总结治疗气管、隆凸部肿瘤患者围手术期呼吸问题的经验 ,探讨防治这类肿瘤患者术后严重呼吸并发症的方法。方法 回顾性分析 38例气管或隆凸部肿瘤患者的术前肺功能改变、手术后并发症、手术方式和围手术期呼吸问题的处理。结果 术前 2 9例 (76 .3% )患者有肺通气功能障碍。术后 2 1例患者共发生 45例次并发症 ,其发生率为 5 5 .3% (2 1/ 38) ,其中呼吸道并发症占80 .0 %。 17例患者隆凸全肺切除术或隆凸切除及成形术后 ,发生并发症 2 8例次 ;2 1例其他术式的患者 ,发生并发症 17例次。本组死亡 4例 ,死亡率为 10 .5 %。结论 纤支镜引导直视下清醒插管、正确的术式选择、精良的吻合技术、术后呼吸机辅助呼吸、积极抗感染和营养支持是防治围手术期呼吸道并发症的必要手段。

Objective To summarise and analyse the experience and methods of managing the perioperative respiratory problems in patients with tumor of trachea or carina surgically treated during the last decade, and the ways of preventing severe postoperative respiratory complications in the future. Methods Thirty-eight patients with tumor of trachea or carina surgically treated from 1991 to 2000 by different modes of tracheobronchial plastic surgery were retrospectively studied to summarise and analyse the changes in preoperative pulmonary function, postoperative complications and the management of perioperative respiratory problems.Results Out of 38 patients, 29 (76.3%) gave abnormal results to preoperative pulmonary function tests. 55.3% (21/38) of the whole series developed 45 postoperative complications with respiratory complications as the major one (80.0%). Seventeen patients who had undergone carinal pneumonectomy or carinal resection plus reconstruction gave far more complications (28 complications) than the remaining 21 patients treated by other modes of surgery (17 complications). Four patients died of postoperative complications with a mortality rate of 10.5%.ConclusionPatients treated with carinal pneumonectomy or carinal resection plus reconstruction give much more complications than patients treated by any other modes of large airway surgery. Fiberoptic bronchoscopic (FOB) guided intubation, precise surgical treatment, postoperative mechanical ventilation support, use of effective antibiotics and sufficient nutritional support are important for a successful management of these patients.