「葉克膜」應用於氣管內腫瘤引起的呼吸道阻塞－病例報告

Extracorporeal Membrane Oxygenation Support for Treatment of Tracheal Tumor with Airway Obstruction-Case Report

張竣翔(Chun-Hsiang Chang) ； 李志賢(Chih-Hsien Lee) ； 張凱惟(Kai-Wei Chang) ； 曹唐義(Tang-Yi Tsao) ； 蔡青劭(Stella Chin-Shaw Tsai)

《台灣耳鼻喉頭頸外科雜誌》 56卷3期 (2021/09) Pp. 175-180

https://doi.org/10.6286/jtohns.202109_56(3).175

摘要

呼吸道狹窄與阻塞，一直以來是呼吸道急症裡一個重要的議題。1名59歲女性，在4年前因為聲音沙啞到他院求診，診斷是左側的甲狀腺，疑似惡性腫瘤合併同側聲帶麻痺。由於氣切可能是治療選項之一，患者繼而拒絕治療及後續追蹤。然而最近半年因為呼吸困難加劇伴隨喘鳴至本院就診。理學檢查發現左側有一顆硬且不規則的甲狀腺腫瘤。在鼻咽喉內視鏡檢查發現左側聲帶麻痺。頸部的電腦斷層報告顯示有雙側不對稱的多發性甲狀腺結節，並且左側甲狀腺腫瘤由聲門下位置直接侵襲進入氣管壁，腫瘤的大小約29×35×33 mm。由於病人的呼吸道有嚴重的阻塞，透過氣管內管置入術或者是緊急氣管切開術去做呼吸道的支持是有困難的，經過與胸腔外科和心臟外科討論之後，並且與病人以「醫病共享決策」模式充分溝通，決定先使用體外膜氧合（ECMO）來支持病人的血氧濃度，接著用支氣管鏡清除氣管內的腫瘤後，全身麻醉下進行雙側全甲狀腺切除術併左側頸部淋巴廓清術。病人術後順利移除ECMO，並且在術後第3天順利移除氣管內管。此病例報告提供另一種呼吸道支持的選擇。

關鍵字

airway obstruction ； ECMO ； subglottic tumor ； thyroid neoplasm（呼吸道阻塞 ； 體外膜氧合 ； 聲門下腫瘤 ； 甲狀腺腫瘤）

並列摘要

Respiratory tract stenosis and obstruction have been an important issue in respiratory emergencies. A 59-year-old woman presented with hoarseness to another hospital 4 years ago. She was suspected to have a malignant tumor in the left thyroid gland with ipsilateral vocal cord paralysis. Since tracheotomy was suggested as a treatment option, the patient refused treatment and was lost to follow-up. However, in the past 6 months, she developed increasing dyspnea accompanied by stridor. Physical examination revealed a hard, irregular thyroid tumor on the left side. Endoscopy revealed paralysis of the left vocal cord. Computed tomography of the neck showed bilateral asymmetric multiple thyroid nodules and that the left thyroid tumor directly invaded the tracheal wall from the subglottic area to the trachea. The size of the tumor was approximately 29 × 35 × 33 mm. The patient's airway was severely obstructed and could not be supported by an endotracheal tube placement or emergency tracheotomy. Hence, after discussing with the thoracic surgeon, the cardiac surgeon, and the patient, we decided to use extracorporeal membrane oxygenation (ECMO) to support the patient's blood oxygenation. After bronchoscopic resection of the endoluminal tumor, we performed bilateral total thyroidectomy and left neck dissection under general anesthesia. The patient was successfully weaned from ECMO, and the endotracheal tube was removed on the third day after surgery. This case report provides another option for respiratory support in a difficult case of acute airway obstruction.

並列關鍵字

airway obstruction ； ECMO ； subglottic tumor ； thyroid neoplasm