颈椎脊索瘤行肿瘤切除术的麻醉管理1例

Anesthesia management of cervical chordoma resection: A case report

脊索瘤是一种生长缓慢、具有局部侵袭性的低度恶性肿瘤,患病率约为十万分之一,占所有恶性骨肿瘤的1%~4%[1]。目前认为脊索瘤起源于异位的胚胎性脊索组织,可发生在脊柱的从颅底到骶骨的任何部位,50%左右发生于骶尾部,30%左右发生于颅底,其余发生于活动的脊柱区域,颈椎脊索瘤较为罕见[2-3]。颈椎脊索瘤可能伴随困难气道,特别是上颈椎,瘤体向前压迫咽喉部,可引起上呼吸道梗阻,若麻醉处理不当,患者可因窒息而死亡。本文报道了北京大学第三医院收治的1例颈2椎体脊索瘤行肿瘤切除术的围麻醉期处理经过。

Chordoma is a slow-growing,locally invasive,low-grade malignant tumor with a prevalence of one in 100 000,accounting for 1%-4%of all malignant hone tumors.At present,it is considered that chordoma originates from ectopic embryonic chordal tissue and can occur in any part of the spine from the skull base to the sacrum.About 50%of chordoma occurs in the sacrococcygeal region,about 30%in the skull base,and the rest occurs in the active spinal region.Cervical chordoma is rare,but it may be accompanied by difficult airways.The tumors compress the pharynx and throat forward,which can cause upper airway obstruction.If the anesthesia is not properly handled,the patient may die of asphyxia.The core issues of airway management during the perioperative period of cervical chordoma surgery involve three main parts;preoperative airway evaluation,airway management and extubation management.Diffi cult airway assessment often relies on physical examination indicators,such as inter-incisor gap,thyro-mental distance,neck circumference,Mallampati test,etc.But the accuracy is insufficient.The appli cation of imaging examination in the observation of different tissues can make up for the inaccurate evalu ation of the internal structure of the airway.Because chordoma destroys cervical vertebral body and acces sories,cervical stability is impaired.Excessive cervical vertebral extention should be avoided during tra cheal intubation to prevent severe compression of the spinal cord.It is better to fix the head by an assis tant and perform neutral tracheal intubation.Considering that the patient with a difficult airway that could be predicted before operation,the strategy of tracheal intubation under conscious sedation with topical anesthesia was selected.After sedation and topical anesthesia,the patient was successfully intubated with optical stylet.After operation,the patient returned to ICU with tracheal catheter.On the 4th day after operation,the tracheal tube was pulled out.On the 5th day after operation,the patient was transferred to the orthopaedic ward and discharged on the 7 th day after operation.It is of great significance to establish specific strategies for such operations to reduce related complications,speed up post-operative rehabilita tion and save medical resources.We reported the anesthetic management of cervical chordoma cured in Peking University Third Hospital.