Bougaki Masahiko, Orii Ryo, Yamada Yoshitsugu
Department of Anesthesiology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655.
Masui. 2007 Dec;56(12):1411-3.
A 74-year-old man was scheduled for resection of a pulmonary tumor in the left upper lobe. He had asymptomatic complete situs inversus, and therefore his left lung had three lobes whereas his right lung had two. Since the tumor had been growing through the left upper bronchus into the left main bronchus, it seemed that the use of a bronchial blocker in the left bronchus should be avoided. A 37-Fr left-sided double-lumen tube was rotated in the opposite direction (clockwise) and advanced easily into the right (anatomically left) main bronchus under fiberoptic guidance. One lung ventilation during the operation was performed successfully and there was no postoperative airway complication. Several ways of achieving one lung ventilation in patients with situs inversus are discussed in this report. The use of a bronchial blocker should be considered first-choice, but sometimes its use is inappropriate as in this case. Commercially available double-lumen tubes are not intended for use in cases of situs inversus. If a double-lumen tube is desired, intentional right bronchial insertion of a left-sided double-lumen tube seems to be an easy and reliable option.
一名74岁男性计划接受左肺上叶肺肿瘤切除术。他患有无症状的完全性内脏反位，因此其左肺有三个叶，而右肺有两个叶。由于肿瘤已通过左肺上叶支气管生长至左主支气管，似乎应避免在左支气管中使用支气管封堵器。将一根37F的左侧双腔管向相反方向（顺时针）旋转，并在纤维支气管镜引导下轻松推进至右（解剖学上的左）主支气管。手术期间单肺通气成功实施，术后无气道并发症。本报告讨论了在内脏反位患者中实现单肺通气的几种方法。支气管封堵器的使用应被视为首选，但有时像本病例一样其使用并不合适。市售双腔管并非用于内脏反位的情况。如果需要使用双腔管，将左侧双腔管有意插入右支气管似乎是一种简单且可靠的选择。
