喉癌根治术后患者胸腔镜下右肺肿瘤切除麻醉处理1例

A Case Report on Anesthetic Management of the Lung Cancer After Total Laryngectomy with Thoracoscopic Lung Resection

目的:探讨喉腔术后颈部解剖结构改变的患者如何选择安全有效的麻醉方法。方法:分析1例喉癌根治术后需在胸腔镜下行右肺肿瘤切除的患者的临床特征及麻醉处理过程。结果:喉切除术破坏了喉和颈部的解剖结构和生理功能,术后喉腔内出现大量瘢痕增生及肉芽生长,颈部解剖结构受到破坏,不同区域的狭窄及程度决定了麻醉方法的选择。结论:对于患有喉部疾病或者曾经因喉部疾病行气管插管全麻的患者,术前必须进行充分的气道评估,在保留自主呼吸的麻醉方式下行气管插管是相对安全的。

Objective：To investigate the anatomy changes in cavum laryngis after total laryngectomy and choose a safe and effective anesthesia method.Methods：To analyze the clinical features and anesthesia process in one case of the lung cancer patient after total laryngectomy with thoracoscopic lung resection.Results：Laryngectomy destroyed the anatomical structures and physiological functions of the throat and neck,a lot of scars and granulation appeared in the throat,which damaged the anatomy of the neck.The degree of stenosis in different regions determines the choice of anesthetic methods.Conclusion：For patients with laryngeal diseases or those who once had undergone general anesthesia of endotracheal intubation for laryngeal disease,preoperative airway evaluation must be carried out fully.Considering keeping spontaneous breathing,anesthesia of endotracheal intubation is relatively safe.