自制加强型气管导管用于食管–支气管瘘修补术的麻醉处理一例

A Case of Self-Made Reinforced Tracheal Tube Used in Anesthesia for Esophagus-Bronchial Fistula Repair

摘要: 一名患有食管癌的49岁男性，于2021年1月14日行全身麻醉下胸腹腔联合食管癌根治术，手术顺利。术后出现反复咳嗽、咳痰，伴胸闷喘憋。行上消化道造影示：吻合口瘘、食管支气管瘘。给予对症支持治疗效果欠佳，术后多次行食管覆膜支架置换及调整术，症状均未明显改善，食管造影仍可见食管支气管瘘口。因此，在多学科会诊下讨论了全身麻醉下的气道管理，选择了内径为5.5毫米的自制加强型气管导管。这种气道管理保证了手术期间充分的氧合，并为气管镜在气道内的操作提供了足够的空间。最终，效果满意。

Abstract: A 49-year-old male with esophageal cancer underwent a successful radical surgery under general anesthesia on January 14, 2021. Postoperatively, he experienced recurrent coughing, sputum pro-duction, chest tightness, and dyspnea. Upper gastrointestinal contrast imaging revealed an anas-tomotic fistula and an esophagobronchial fistula. Symptomatic supportive treatment was ineffec-tive, and multiple replacements and adjustments of the esophageal covered stent were performed postoperatively, but the symptoms did not improve significantly, and the esophagobronchial fistula remained visible on esophageal imaging. Therefore, multidisciplinary consultation was conducted to discuss airway management under general anesthesia, and a homemade reinforced tracheal in-tubation with an inner diameter of 5.5 millimeters was chosen. This airway management ensured adequate oxygenation during surgery and provided sufficient space for the operation of the bron-choscope in the airway. Ultimately, the outcome was satisfactory.