A case of celiac synaptic cell sarcoma with paratumor natural blister anaesthetic

patient, !---- female, 30 years old, weighing 50kg, 155 cm tall, ASAIII gradewas admitted to hospital for 18 months due to decay and ulcers in the mouth mucosapatients 18 months ago (20d after natural delivery) appeared oral erosion, ulcers accompanied by persistent pain, after treatment in the external hospital to give the symptoms of ath- and amaldo nylon treatment20d before the symptoms of aggravation, oral erosion bleeding, open mouth restriction, eating difficulties, the appearance of the abdomen, hands and feet skin papules, itching, scratching after the emergence of blisters, after breaking the knot, followed by the appearance of vulva itching, mucous membrane erosion and oozingupper abdomen B over-indication: hepatic and renal gap real positioninto a walk upper abdomen MRI show: right kidney after the upper occupatic lesions, size of about 13.5 cm x 8.8 cm x 8.5 cm, clear boundary, adjacent liver and right kidney pressure, suspected of giant lymph node hyperplasia may bethe pathological results of the skin tissue of the lips and feet showed that the paratumor herpesclinic to "post-abdominal tumor, celiac disease, paratumor natural blisters" admitted to the hospitalis to have a peritonectomy of the peritonal tumor after a general anaestheticpreoperative arterial hemogasise: PCO2 32.5mmHg, PO2 89.6mmHg; RATIO (MONO) 0.13 X 109/L, EOSINOPHIL RATIO (EOS) 0.09 X 109/L, LYMPHOCYTE RATIO (LYM) 1.09 X 109/L, RED BLOOD CELL PRESSURE (HCT) 0.322G/L, RBC3.49 X 1012/L, HB100G/L, ABNORMAL LYMOMORPHOS;chest CT, ECG and cardiac super-examination did not show any significant abnormalitiesAfterpatients entering the room, routine ECG, SpO2, noninvasive blood pressure monitoring, HR102 times/min, BP118/73mmHg, SpO299%the establishment of peripheral venous pathway, infusion of compound lactic acid sodium 500 ml, intravenous give midazolam 2 mg, shufentanil 5 mg, methyl strong pine dragon 80 mg, ethyl ether 1 mg muscle injection1% Lidoca inthem, the left side of the line artery punctured the tubeotolaryngologist in the bureau of hemp underlying tracheotomy, see trachea mucosa congestion, scattered in the decay point, low pressure attraction airway secretions after placed in the trachea casing, fixed connected ventilator manual ventilation, listening to the double lung breathing sound clear symmetry, stitching incisionexposed trachea rings, intravenous injection of sufentani 15 sg, propofol 50mg and shun aquor ammonium 12mg for anesthesia induction, followed by mechanical ventilation, VT6 to 8 ml/kg, RR10 to 15 times / minute, PEEP 3 cmH2O, inhalation 50%O21.0 to 1.5L/ min, I:112, maintenance of PET2 inhalation 1.0% to 2.0% heptafluoroether, intravenous pump injection rifentani 0.2 to 0.4 sg-kg-1-min-1, right metorium at 10ng kg-1.min-1, according to the patient's surgical condition intermittent addition of shunaquo ammonium maintenance anesthesia ultrasound-guided downstream right cervical venous puncture tube, monitoring central venous pressure (CVP) and intraoperative rehydration fluid; found that the tumor body is located in the back peritoneum of the liver right back ale and the right kidney, about 13 cm x 10 cm x 8 cm, the boundary is clear, the envelope is complete, the surrounding blood supply is rich, bleeding more when separated i.e action blood gas analysis shows: Hb73g/L, Hc25.2%, Blood Lacate acid (Lac) 1.4mmol/L, pH and K plus, Na plus, Ca2 plus concentrations are normal accelerated infusion 130/0.4 hydroxyethyl starch 500ml, suspended red blood cell 3U, 30min after review of arterial blood gas display: Hb73g/L, Hc24.8%, Lac 2.0mmol/L maintenance of HR80 to 100 times/ minute, SBP90 to 130mm-Hg, DBP50 to 85mmHg, CVP4 to 10 cmH2O, SVV 13%, PPV and PVI 15%; surgery lasted 220min, a total of 1500 ml of crystal fluid, 500 ml of colloidal fluid, suspended red blood cells 600 ml, bleeding 1000 ml, urine volume of 500 ml surgery with trachea casing sent ICU further treatment, the second day after surgery smoothly offline sustained airway humidification, the 11th day after surgery transferred back to the general ward, the 13th day after surgery, please otolaryngology consultation to replace the trachea casing and block the tube, the 20th day after surgery patients mouth, oral erosion, bleeding and skin mucosa symptoms significantly improved than before surgery, recommended to continue the internal surgery The tumor pathology that was removed during surgery combined with immunohetic osticed bubbling dendritic cell sarcoma (low malignancy) discussed follive dendritic cell sarcoma (Follium dendritic cell sarcoma), a rare type of barracuda-shaped cell sarcoma, rarely seen after the peritoneum and rarely reported by people with post-abdominal FDCS-induced paratumor natural hertosis paraneoplastic pemphigus (PNP) is a rare autoimmune side tumor disease whose pathogenesis may be combined with autoimmune antibody IgG and antigen bridge particles produced by tumor tissue in the body to form an immune complex, which is then deposited in the epithelial and mucous membranes to form herpes there is a certain speciality in the anaesthetic management of such patients during perioperative preoperative assessment: (1) anaesthetic intubation assessment patients with lip bleeding, conjoined with persistent severe pain, mouth degree only half finger, mouth, nasal mucous membrane large area erosion, is a difficult airway PNP patients can cause changes in respiratory epithelial cells, the course of progress, may lead to abstinent bronchitis (bronchiolitis obliterans, BO), surgical excision, can cause a large number of antibodies in tumor cells release, induce the occurrence of BO, development, and thus lead to respiratory failure death comprehensive analysis and develop ananaesthetic program for tracheotomy (2) Assessment of the possibility of tumor removal surgery preoperative abdominal aortic CT angiomatology prompts the abdominal blood supply rich, during surgery may occur hemorrhage, preoperative preparation of circulatory monitoring equipment, blood preparation products (3) patients 16 months before surgery began to intermittently give methyl nylon sodium acetate treatment, anesthesia-induced pre-intravenous injection of methyl strong pine dragon 80mg, to avoid stress-induced adrenal cortex risk, and pNP treatment has a certain effect; management: (1) Airway management auxiliary ventilation to give Vaseline dressing to protect the lip, tracheotomy when the action is gentle, choose the appropriate trachea casing, low negative pressure (about 100mmHg) under sputum, to avoid aggravating mucosal damage (2) capacity management operative scan has record blood pressure, CVP, SVV, PPV, PVI monitoring, pay close attention to the intake volume, combined with dynamic blood gas analysis results, to achieve the target target liquid treatment postoperative follow-up: (1) Proper calm, adequate analgesia (2) break sie with the ventilator combined with postoperative chest CT and arterial hemogasanalysis, the patient successfully disengaged from the ventilator on the second day after surgery PNP were most common in blood diseases, including non-Hodgkin lymphoma (38.6%), chronic lymphocytic leukemia (18.4%), Castleman disease (18.4%), and non-hematologic tumors (8.6%) and sarcoma (6.2%) the patient was highly suspected before surgery that PNP was associated with post-peritoneal Castleman disease, while the tumor pathology of intraoperative excision combined with immunohiscitision was a preliminary diagnosis of FDCS the choice of glucocorticoid therapy to reduce the production of autoantibodies, and after tumor removal, the patient's mucosal skin loss symptoms improved significantly compared to preoperative, but also supported the treatment view of FDCS, that is, surgical excision FDCS is the first choice for the treatment of primary lesions , after the peritoneum FDCS induced paracancerous scabies is rare, such patients to the perigenerale anaesthetic management brought some difficulties must comprehensively assess the patient before surgery, develop a detailed and safe anaesthetic plan, pay close attention to the patient during surgery, achieve accurate anesthesia management, and achieve a smooth transition after surgery, which is conducive to the patient's recovery