体外生命支持技术在气管外科中的应用——单中心经验

Intraoperative extracorporeal life support in tracheal surgery:a single-center experience

目的 评价体外生命支持(ECLS)技术在危重气管外科术中应用的安全性和优越性。方法 通过单中心回顾性研究,收集了2000年1月至2020年12月在体外膜氧合(ECMO)或体外循环(ECC)支持下接受高危气管外科手术的患者数据。评估基线特征、住院并发症、ECLS管理、手术相关数据和死亡率。结果 数据收集期限内,共107例患者在手术过程中接受了ECMO或ECC支持,其中男性67例(62.6%),中位年龄为48.9岁(14~76岁),手术涉及气管肿瘤67例、气管狭窄23例、气管压迫9例和气管瘘8例。ECLS模式包含ECC(n=28,26.2%),改良ECC技术(n=19,17.8%),静脉-静脉ECMO(V-V ECMO,n=44,41.1%)或静脉-动脉ECMO(V-A ECMO,n=16,15.0%)。ECMO和改良ECC组采用无肝素(n=18,16.8%)或低剂量肝素(n=61,57.0%)辅助。ECC、改良ECC、V-V和V-A ECMO的中位辅助时间为49、67、144和118 min。分别有8例患者(7.5%)出现术中并发症(大出血、低氧、循环不稳定),23例患者(21.5%)出现术后并发症(吻合口瘘、肺不张、呼吸道感染和支气管胸膜瘘)。ECC组输血更多(14/28),但与其他组比较,在输血量上没有显著差异。全部患者围术期死亡率为6.5%(n=7)。结论 尽管ECLS技术较少用于胸外科手术,但在选择性的危重气道术中,ECC或ECMO提供充分的气体交换或稳定的血流动力学,其中ECMO在安全性和便捷性上更具优势。

Objective To evaluate the safety and superiority of extracorporeal life support(ECLS) in critical tracheal surgery.Methods As a single-center retrospective study,the data of patients undergoing high-risk tracheal surgery supported with extracorporeal membrane oxygenation(ECMO) or cardiopulmonary bypass(CPB) from January 2000 to December 2020were collected.Baseline characteristics,hospitalization complications,ECLS management,surgery-related data,and mortality were evaluated.Results A total of 107 patients received ECMO or CPB support during the study period,including 67 males(62.6%) with a median age of 48.9 years(range,14-76 years).Surgical procedures involved the trachea tumour(67 cases),tracheal stenosis(23 cases),tracheal compression(9 cases),and tracheal fistulas(8 cases).Classic CPB(n = 28,26.2%),modified CPB(n = 19,17.8%),and veno-venous ECMO(VV-ECMO,n = 44,41.1%) or veno-arterial ECMO(VA-ECMO,n = 16,15.0%)were used during twenty years.ECMO and modified CPB groups used heparin-free(n = 18,16.8%) or low-dose heparin(n = 61,57.0%).The median pump duration of CPB,modified CPB,VV and VA ECMO was 49,67,144 and 118 minutes,respectively.Intraoperative complications(massive hemorrhage,hypoxia and unstable circulation) occurred in 8 patients(7.5%),and postoperative complications(anastomotic leakage,atelectasis,respiratory tract infection and bronchopleural fistula) occurred in 23 patients(21.5%).More patients in CPB group(14/28) received blood transfusion,but there was no significant difference in blood transfusion volume compared with other groups.The perioperative mortality rate was 6.5%(n = 7).Conclusion Despite intraoperative cardiopulmonary support being rarely used in tracheal and carinal disease,the critical tracheal disease can be successfully treated with CPB or ECMO.ECMO provides safe and effective gas exchange to ensure a safe and smooth procedure and it is the most commonly used technology during surgery in recent years.