腹腔镜肾切除术中致命二氧化碳气栓的成功救治：病例报道

腹腔镜肾切除是治疗肾脏疾病的微创术式，但在气腹下可能伴发罕见却致命的二氧化碳气体栓塞。我们报道了一例患者，在行腹腔镜肾切除断肾静脉时发生反常的二氧化碳气栓。病人出现严重的血流动力学不稳。食道超声发现患者左心室大量气泡，无先天右向左分流孔道。患者经CPR和血管活性药支持后成功救治。术后十一天出院，无任何并发症。我们同时回顾了类似文献报道，腔镜肾切除术中气体栓塞虽然罕见必须被视为术中突发心血管功能衰竭的可能原因，快速诊断和及时治疗可以显著减少气栓并发症的病死率。

Title: Successful resuscitation after fatal carbon dioxide embolism during laparoscopic nephrectomy

Laparoscopic nephrectomy (LN) is a less invasive surgical option for patients with renal disease. It may be complicated with disastrous CO2 embolism which is very rare however a life-threatening consequence during pneumoperitonem.We reported a case of paradoxical CO2 embolism during the surgeon cutting the renal vein in a scheduled laparoscopic nephrectomy. The patient developed serious hemodynamic deterioration and remarkably decreased end-tidal carbon dioxide level. Transesophageal echocardiograpy (TEE) verified paradoxical CO2 emboli in the left heart chambers without intracardiac right-to-left shunt. Fortunately the patient was successfully resuscitated and stabilized after cardiopulmonary resuscitation (CPR) and inotropic drug supported. Eleven days after the operation, she was discharged without any complications. Although rare, gas embolism must be considered as a possible cause of sudden cardiocirculatory failure during LN, Rapid diagnosis and definitive intervention can decrease fatality from such an injury.