无管麻醉技术在气管肿瘤切除术中的应用：一例病例报告

文献信息

中文摘要

背景： 下咽癌新辅助免疫治疗后发生全身性血管瘤是新辅助免疫治疗的常见并发症之一。其发病机制可能与多种免疫调节失衡及血管生物学改变有关。方法：本例为一名局部晚期下咽癌患者，接受了新辅助免疫治疗及全喉切除联合部分下咽切除术。随访期间发现气管中段有一肿物，突入气管腔。结果：本例的特殊性在于气管肿物位于气管中段，管腔狭窄。麻醉时，气管插管置于肿物上方或下方均会影响手术。经过多学科团队讨论，采用了无插管麻醉方案，使用艾司氯胺酮，其能良好维持自主呼吸，保证足够的麻醉深度，并减少支气管痉挛的发生。气道管理主要采用高流量鼻导管，提供大流量和流速，延长无呼吸和氧合的安全期，为手术提供安全保障并确保其成功完成。结论：

英文摘要

Systemic hemangioma after neoadjuvant immunotherapy for hypopharyngeal carcinoma is one of the common complications of neoadjuvant immunotherapy. Its pathogenesis may be related to multiple immune regulatory imbalances and vascular biological changes. This case was a locally advanced hypopharyngeal cancer patient who received neoadjuvant immunotherapy and total laryngectomy with partial hypopharyngectomy. During follow-up, a mass was found in the middle part of the trachea, protruding into the tracheal lumen. The peculiarity of this case was that the tracheal mass was located in the middle part of the trachea, with a narrow lumen. During anesthesia, whether the tracheal intubation was placed above or below the mass would affect the operation. After multidisciplinary team discussion, a no-intubation anesthesia plan was adopted, using esketamine, which could maintain spontaneous breathing well, ensure sufficient depth of anesthesia, and reduce the occurrence of bronchospasm. The airway management mainly used high-flow nasal cannula to provide a large flow and flow rate, prolonging the safe period without breathing and oxygenation, providing a safety guarantee for the operation and ensuring its successful completion.