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患者男性,49岁.因进食困难半年,经食管造影诊断为食管中段癌于1990年9月3日入院.1990年9月15日在全麻、双腔支气管导管插管下行右经胸食管癌根治术.选用上海新亚医用橡胶厂1987年生产39~＃左侧双腔支气管导管(简称双腔管),插管顺利,分别单侧通气时胸廓运动良好,呼吸音正常.全麻后取右胸抬高45°、腹部平卧之体位.手术分胸腹两组进行.游离食管时作左侧肺通气.游离中上段食管后改双肺通气,麻醉师于气管内吸出血性液体,术者发现气管有漏气,仔细检查见气管隆突上方约3cm处气管膜部破裂约为0.8cm,双腔管隆突钧顶部露出,双腔管顶端适对左主支气管开口.因无法更换气管插管,故剪去整个隆突钩,将双腔管前进3cm至左主支气管内,行左肺通气.细丝线间断缝合气管破口3针并以纵隔胸膜覆盖.退出双腔管至总气管作双肺通气,证实气管破裂处无漏气后完成左颈部食管胃吻合术.关胸拔除双腔管后见
The patient was a 49-year-old male patient who had difficulty eating for six months. He was diagnosed with esophageal angiography and was admitted to hospital on September 3, 1990. He underwent transesophageal double-lumen catheterization in the right transthoracic esophageal cancer on September 15, 1990. Radical surgery. Shanghai Xinya Medical Rubber Factory was used to produce 39~# left double-lumen bronchus catheter (double lumen tube) in 1987. The intubation was successful. The thoracic movement was good and the breath sounds were normal when unilateral ventilation. After general anesthesia Right chest elevation 45 °, abdomen supine position. Surgery for the chest and abdomen in the two groups. When the free esophageal left lung ventilation. After the free upper middle esophagus to double lung ventilation, anesthetists in the trachea suction hemorrhagic fluid, surgery The patient found a gas leakage in the trachea. After careful examination, the rupture of the tracheal membrane at approximately 3 cm above the tracheal carina was approximately 0.8 cm. The top of the double lumen tube was exposed and the top of the double lumen tube was open to the left main bronchus. The trachea could not be replaced. Intubation, so cut the entire protuberance hook, the double-lumen tube forward 3cm to the left main bronchus, left lung ventilation, microfilament sutured tracheotomy 3 needles and covering the mediastinal pleura. Exit the double lumen to the total trachea For double-lung ventilation, confirmation of complete rupture of the trachea and completion of the left cervical esophagus Stomach anastomosis. See the chest after removing the double lumen