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舌癌根治术后气切并发大出血1例
A 55-year old middle-aged male presented swelling lymph nodes in neck and mass in left tongue for three mouths.Physical examination shows a size 5 cm× 5 cm mass in tongue and went over the midline.The mandibular lymph nodes were touched with moderate tenderness and little mobility in bilateral.The laboratory results,function of the kidney and heart liver,nasopharyngeal fiber area were basically normal.The result of CT and MRI shows the mass reached the lingual muscle layer and several suspected metastatic lymph nodes in neck.Pathological examination shows much atypical squamous cell reached muscle layer,diagnosed as highly differentiated squamous cell carcinoma.We determined to treat the patient with removal of primary lesion and bilateral neck dissection.We performed tracheotomy after the operation.During the surgeon's blunt dissection of the trachea surrounding tissue,the hemorrhage occurred.After staunching the blood,we transferred sternocleidomastoid muscle flap to fill the soft gas space and finished the surgery.
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1例舌癌根治术行气管切开并发无名动脉大出血患者的护理
舌癌是常见的口腔癌，主要是以手术治疗为主，手术方式以切除原发病灶加同侧颈部淋巴结清扫术，舌缺损1／2以上同时行舌再造术。由于手术切除范围广，损伤大，手术后舌部会出现明显肿胀，为维护气道的安全，避免术后发生呼吸困难，提高手术成功率，术中预防性气管切开是临床治疗的必要手段［1］。而气管切开术存在一系列并发症，如皮下气肿、气胸、肺部感染等。大出血是气管切开术的严重并发症，其中无名动脉破裂出血具有致命性，一旦发生，抢救成功率几乎为零。本科室于2015年3月收治1例舌癌患者行左舌颌颈联合根治术＋股前外侧皮瓣转移缺损修复术＋气管切开术后并发无名动脉大出血，经及时抢救、有效护理患者治愈出院，现将护理体会报道如下。
