気管乳頭腫切除時に気管食道瘻を来し気道管理に難渋した小児喉頭気管乳頭腫の1症例

A Case of Difficult Airway Management due to Acquired Tracheoesophageal Fistula Incidental to Tracheal Papilloma Resection in a 2-year-old Child

要旨

　2歳・男児に対して全身麻酔下気管乳頭腫切除術を施行した。手術中に硬性気管支鏡による気管食道瘻を併発し換気不良となった。気管腫瘍手術時は術中気道損傷による換気不全にも対応できる気道管理計画と準備が重要であると考えられた。

　Rigid bronchoscopic tracheobronchial resection of papilloma was performed under general anesthesia for recurrent tracheobronchial papilloma in a 2-year-old boy undergoing laryngeal papilloma cautery and tracheostomy. During the operation, the patient had difficulty with ventilation and oxygenation and the surgery was discontinued. Ventilation and oxygenation were temporarily improved by manual ventilation through a tracheostomy tube；however, gastric distension and the bronchoscopic findings suggested accidental perforation of the trachea, with formation of a tracheoesophageal fistula during the procedure. During airway surgery, it is important to plan airway management carefully and to be prepared for dealing with unexpected ventilation problems.