腹腔镜微波凝固治疗中氩气栓塞的应用
Argon gas embolism in the application of laparoscopic microwave coagulation therapy.
作者信息
Ikegami Toru, Shimada Mitsuo, Imura Satoru, Nakamura Tomoka, Kawahito Shinji, Morine Yuji, Kanemura Hirofumi, Hanaoka Jun
机构信息
Department of Surgery, The University of Tokushima, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan.
出版信息
J Hepatobiliary Pancreat Surg. 2009;16(3):394-8. doi: 10.1007/s00534-008-0039-5. Epub 2009 Feb 11.
BACKGROUND
A major concern in the use of the argon beam coagulator system is the potential risk of argon gas embolism.
METHODS
Seven cases with argon gas embolism in the English literature were reviewed along with the current case. The latter case was a 77-year-old female having laparoscopic hepatectomy after application of the microwave coagulation system on the cutting planes.
RESULTS
Immediately following shots of an argon beam to control local bleeding at the needle hole in the liver caused by microwave coagulation, the end-tidal carbon disappeared, followed by cardiovascular collapse. After 18 min of cardiovascular resuscitation, the tumors were resected under laparotomy.
CONCLUSIONS
After reviewing the cases, pneumoperitoneum (57.1%), hepatic needle punctures (42.8%) and direct application of the argon beam to the liver (28.6%) can be considered as risky processes in such events. Caution is necessary in the use of an argon beam in liver surgery to avoid life-threatening gas embolism.
背景
氩气刀系统使用中的一个主要问题是存在氩气栓塞的潜在风险。
方法
回顾了英文文献中7例氩气栓塞病例以及当前这例病例。当前病例是一名77岁女性，在对肝切除断面应用微波凝固系统后接受了腹腔镜肝切除术。
结果
在使用氩气刀控制因微波凝固导致的肝脏针孔处局部出血后，呼气末二氧化碳消失，随后出现心血管功能衰竭。经过18分钟的心肺复苏后，通过开腹手术切除了肿瘤。
结论
在回顾这些病例后，气腹（57.1%）、肝脏穿刺（42.8%）以及直接对肝脏应用氩气刀（28.6%）可被视为此类事件中的风险操作。在肝脏手术中使用氩气刀时必须谨慎，以避免危及生命的气体栓塞。
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