甲状腺癌の喉頭浸潤による気道狭窄症例の麻酔経験 Anesthetic Airway Management of Severe Airway Stenosis Due to Thyroid Carcinoma

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  甲状腺癌の喉頭浸潤により,気管断面積がCT上で40%以下に減少した50歳の女性の麻酔管理を経験した.喉頭全摘術および頚部郭清術が予定されたが,声門部に腫瘍状組織が浸潤しており,挿管困難と思われた.意識下に経鼻的ファイバースコープによる挿管を試みたが,声門の通過は不可能であったため,局所麻酔下に大腿動静脈よりカニュレーションを行い,経皮的心肺補助による体外循環下に気管切開を行った.気管切開後はモンタンドンチューブを挿入し,全静脈麻酔による全身麻酔下に予定術式を完了した.手術翌日に人工呼吸から離脱し,その後は順調に経過した.迅速な体外循環の開始により,重度の気道狭窄症例を安全に管理し得た.

  We present the case of a 50-year-old female with severe dyspnea caused by advanced invasive thyroid carcinoma. Total thyroidectomy, laryngectomy, and neck dissection under general anesthesia were scheduled; however, airway management proved problematic. Cervical CT revealed the minimum tracheal cross-section as reduced to ≤40% of normal. Because nasal fiberoptic tracheal intubation proved impossible due to invasive tumorous tissue obstructing the glottis, we initiated percutaneous cardiopulmonary support (PCPS). Cannulation was performed via the femoral vein and artery under local anesthesia; remifentanil was administered during cannulation. Oxygenation became satisfactory following initiation of PCPS. We then induced general anesthesia with propofol-remifentanil, and tracheostomy was performed under PCPS. The patient began ventilating artificially via a Montandon tube, and was smoothly weaned from the extracorporeal circulation by PCPS. No surgical complications occurred. The postoperative course was uneventful, and she was discharged after 26 days. The prompt initiation of PCPS enabled safe anesthetic management in this case of severe airway stenosis.

収録刊行物

  • 日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia

    日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia 32(3), 390-394, 2012-05-15

    日本臨床麻酔学会

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各種コード

  • NII論文ID(NAID)
    10030763287
  • NII書誌ID(NCID)
    AN00330159
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    02854945
  • データ提供元
    CJP書誌  J-STAGE 
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