人工气胸在腔镜食管癌切除术中的临床分析

目的初步探讨胸腹腔食管癌切除术中,建立人工气胸对呼吸、循环的影响,评价其安全性及可行性。方法2010年5月至2011年6月本院在人工气胸条件下采用胸腔镜联合腹腔镜食管癌切除术治疗食管癌患者80例,其中双腔气管插管60例、单腔气管插管20例。在充气流速3 L/min、维持胸内压6～8 mmHg的条件下,监测心率、有创动脉压(ABP)、脉搏血氧饱和度(SpO2)、气道压及呼气末CO2分压(PetCO2)等呼吸、循环指标和血气分析结果,观察其在CO2充气前、后的变化趋势。结果手术开始建立人工气胸后,患者的心率、有创动脉压(ABP)、脉搏血氧饱和度(SpO2)基本没有变化,气道压、PetCO2及CO2分压(PCO2)均有不同程度升高,血气pH值下降,停止充气后,检测指标均恢复至基础值水平。所有病例均顺利完成胸腹腔食管癌切除腔镜食管癌切除术,术后仅1例患者由于误吸出现肺部并发症,其余患者均无肺部并发症发生,所有患者均顺利出院。结论在胸腹腔镜下行食管癌切除术中,在充气流速3 L/min、胸内压维持6～8 mmHg,采用二氧化碳建立人工气胸条件下,其增加显露且安全、有效。与双腔插管相比,单腔插管建立人工气胸对患者的呼吸影响更小,更为安全。

Application of artificial pneumothorax in thoracoscopic and laparoscopic resection of esophageal carcinoma

Objective To assess the safety and feasibility of artificial pneumothorax in thoracoscopic and laparoscopic resection of esophageal carcinoma and the effect of artificial pneumothorax on respiration and circulation of patients.Methods Eighty patients with esophageal carcinoma underwent thoracoscopic and laparoscopic resection of esophageal carcinoma under artificial pneumothorax in our department from May 2010 to June 2011.Of them,60 had double lumen tracheal intubation and 20 received single lumen tracheal intubation.Their HR,ABP,SpO2,and PetCO2 were monitored when the insufflation velocity was 3 L/min and the intrathoracic pressure was maintained at 6-8 mmHg before and after insufflation.Results No significant change was found in HR,ABP,and SpO2 of the patients after artificial pneumothorax was induced.However,their airway pressure,PetCO2 and PCO2 were differently increased and their pH value was decreased,which returned to normal after insufflation was stopped.The operation was successful for all patients.No complication occurred in the lungs of all patients except in 1 patient due to mistake aspiration.All patients were discharged from hospital smoothly.Conclusion Thoracoscopic and laparoscopic resection is a safe and feasible procedure for resection esophageal carcinoma under artificial pneumothorax when the insufflation velocity is 3 L/min and the intrathoracic pressure is maintained at 6-8 mmHg.The effect of artificial pneumothorax induced by single lumen tracheal intubation is milder than that of artificial pneumothorax induced by double lumen tracheal intubation on the respiration of patients with esophageal carcinoma.