大きな甲状腺腫を有する患者の経鼻胃管挿入困難症。症例報告

Nasogastric tube insertion difficulty in a patient with a large goiter: A case report.

• Ana Cho
• Seokhyung Hong
• Jinyoung So

抄録

大きな甲状腺腫のある患者では麻酔下での気道管理に特に注意が必要である。口径の大きい挿管患者では、経鼻胃管の挿入が困難な場合がある。気管内挿管患者の経鼻胃管挿入を容易にするための方法がいくつか提案されているが、標準的な挿入方法は確立されていない。33歳の男性が、より大きな甲状腺腫を除去するために右甲状腺葉切除術のために当院の耳鼻咽喉科に入院した。甲状腺CTスキャンでは気管置換を伴う巨大な嚢胞性腫瘤が認められた。挿管困難が予想されたが，気管内挿管は成功した．麻酔科医が右鼻孔から経鼻胃管を挿入しようとしたが成功しなかった。次に、血管造影カテーテルを経鼻胃管に挿入し、患者の首を軽度に屈曲させた状態で経鼻胃管を穏やかに挿入した。この試みも失敗した。最後に、経鼻胃管は大腿骨軟骨の前方変位を介して穏やかに挿入された。経鼻胃管は60cmまで進行した。手術が行われ、術後8日目に合併症もなく退院した。

Airway management under anesthesia is given special attention in patients who have large goiters. Nasogastric tube insertion may be difficult in intubated patients with large goiters. Several methods have been proposed to facilitate the insertion of nasogastric tubes in patients with endotracheal intubation; however, a standard insertion method has not been established. A 33-year-old man was admitted to our otolaryngology department for right thyroid lobectomy to remove a larger goiter. A thyroid computed tomography scan revealed a huge cystic mass with tracheal displacement. Although difficult intubation was expected, endotracheal intubation was performed successfully. An anesthesiologist attempted nasogastric tube insertion via the right nostril; however, this was not successful. Next, an angiography catheter was placed in a nasogastric tube, and the nasogastric tube was gently inserted with the patient's neck in mild flexion. This attempt also failed. Finally, the nasogastric tube was gently inserted via anterior displacement of the cricoid cartilage. The nasogastric tube advanced up to 60 cm. Surgery was performed, and the patient was discharged with no complications on postoperative day 8.