Bronchoscopic Treatment Using an Electrocautery Probe for Upper GI Under V-V ECMO for Left Main Bronchus Obstruction Caused by Subcarinal Lymph Node Metastasis in a Case of Lung Squamous Cell Carcinoma

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  • 肺扁平上皮癌の縦隔リンパ節転移による左主気管支完全閉塞に対し，V-V ECMO下に上部消化管用の高周波止血鉗子を用いて救命し得た1例

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Abstract

<p>Background. Central airway obstruction caused by malignancy is difficult to treat. Case. Our patient was a 61-year-old man who had been admitted to our hospital because of dyspnea, cough, and bloody sputum. He showed severe respiratory failure, and chest computed tomography showed that the left main bronchus was occluded by a tumor consecutive with the bifurcation of the trachea. Tracheal intubation did not improve the respiratory failure. Extracorporeal membrane oxygenation (V-V ECMO) was introduced, and tumor excision using an electrocautery probe resulted in the improvement of bronchial obstruction. He was diagnosed with squamous cell carcinoma (Stage IIIB) based on a histological examination of the biopsy tissue, and radiochemotherapy was performed, resulting in marked tumor reduction but inducing a bronchoesophageal fistula. As stent implantation was unsuitable for both the trachea and esophagus, we performed an esophageal bypass procedure. The patient regained his oral intake ability after the procedure. Conclusion. An endotracheal procedure with cauterization can be applied to cases of severe respiratory failure due to airway obstruction on V-V ECMO. The esophageal bypass procedure in this case was successful, and the patient regained his oral intake ability.</p>

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