颈部手术中伴气管憩室的围术期管理

Perioperative management of neck surgery with tracheal diverticulum

摘要:

目的 改善颈部手术中伴气管憩室患者的围术期管理。方法 回顾性分析2017年1月—2022年12月接受颈部手术的头颈部肿瘤患者憩室的CT图像，记录所有检测到的憩室的位置、数量和尺寸(最大轴向直径)，并整理文献中报道的头颈部肿瘤手术中的特殊事件。结果 本研究共纳入1 198例患者，气管憩室的发病率为5.8%(70例)。气管憩室的中位直径为8.22(5.23，11.11)mm。所有气管憩室均出现在气管右侧，其中67例(95.7%)位于T1~T2椎体水平。本研究术后出现纵隔气肿1例，经保守治疗后顺利恢复。文献报道发现，因憩室破裂引起的气胸2例，无法建立机械通气1例，术中气管憩室与淋巴结难以区分1例，反复发生上呼吸道感染1例。结论 气管憩室并不罕见，在颈部手术前应仔细评估CT图像以识别气管憩室。在手术过程中应进行精细的手术，确保安全、准确地切除肿瘤。注意术中换管技巧，谨慎淋巴结清扫，可避免并发症的发生。

Abstract:

Objective To improve the perioperative management of patients with tracheal diverticulum undergoing neck surgery.Methods A retrospective analysis was conducted on CT images of patients with head and neck tumors who underwent neck surgery from January 2017 to December 2022. The location, number, and size (maximum axial diameter) of all detected diverticula were recorded. Special events reported in the literature during head and neck tumor surgery were compiled.Results A total of 1 198 patients were included, with an incidence of tracheal diverticulum of 5.8% (70 cases). The median diameter of tracheal diverticulum was 8.22 (5.23，11.11)mm. All tracheal diverticula were located on the right side of the trachea, with 67 cases (95.7%) at the T1-T2 vertebral level. And we report a case of pneumomediastinum and smooth recovery after conservative treatment. Literature revealed 2 cases of pneumothorax due to diverticulum rupture, 1 case of inability to establish mechanical ventilation, 1 case of difficulty distinguishing tracheal diverticulum from lymph nodes during surgery, and 1 case of recurrent upper respiratory tract infections.Conclusions Tracheal diverticulum is not rare and should be carefully assessed on CT images before neck surgery. Meticulous surgical procedures, gentle intubation, and cautious lymph node dissection during surgery can prevent complications.