Medizinische Klinik II, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
Endoscopy. 2010 May;42(5):405-12. doi: 10.1055/s-0029-1243948. Epub 2010 Mar 4.
Physiological reactions during natural orifice transluminal endoscopic surgery (NOTES) mediastinoscopy may lead to cardiorespiratory depression. The aim of the current study was to assess cardiopulmonary changes during transesophageal mediastinoscopy in an acute porcine model.
Transesophageal mediastinoscopy was performed under general anesthesia in eight female pigs with a bodyweight of 39 +/- 6 kg. Mediastinal access was achieved via a submucosal tunnel. The cardiac index and global end-diastolic volume index (reflecting preload) were measured every 3 minutes by transpulmonary thermodilution. The following parameters were also recorded: mediastinal pressure, heart rate, mean arterial pressure, systemic vascular resistance index (SVRI; reflecting afterload), peak inspiratory pressure, pH, pCO (2), and pO (2).
In three animals, small tears in the parietal pleura resulted in tension pneumothoraces. The associated cardioplumonary deterioration was fatal in one pig. The other two pigs recovered after decompression with a chest tube. In the remaining five animals there were only mild hemodynamic and respiratory changes during mediastinoscopy. There was a significant ( P = 0.005) but minor transient fall in cardiac index, which correlated with a small rise in SVRI (r = - 0.857, P < 0.001). In the pigs with uncomplicated mediastinoscopy, on-demand insufflation via the endoscope resulted in median mediastinal pressures of 4.5 mm Hg (range 2.3 - 10.2 mm Hg). Overall, mediastinal and thoracic structures could be identified without difficulty via the transesophageal approach.
NOTES mediastinoscopy carries a substantial risk of inadvertent development of a pneumothorax. Otherwise, it leads to negligible hemodynamic and pulmonary changes. In conclusion, close monitoring for the presence of a pneumothorax during NOTES mediastinoscopy appears to be mandatory.
自然腔道内镜外科（NOTES）纵隔镜检查期间的生理反应可能导致心肺抑制。本研究的目的是在急性猪模型中评估经食管纵隔镜检查期间的心肺变化。
在 8 只体重为 39 +/- 6 kg 的雌性猪中，在全身麻醉下进行经食管纵隔镜检查。通过黏膜下隧道进行纵隔进入。通过经肺热稀释法每 3 分钟测量心指数和全心舒张末期容积指数（反映前负荷）。还记录了以下参数：纵隔压力、心率、平均动脉压、全身血管阻力指数（SVRI；反映后负荷）、吸气峰压、pH 值、pCO（2）和 pO（2）。
在 3 只动物中，壁层胸膜的小撕裂导致张力性气胸。相关的心肺恶化在一只猪中是致命的。另外两只猪在通过胸腔引流管减压后恢复。在其余 5 只动物中，纵隔镜检查期间仅有轻度的血液动力学和呼吸变化。心指数有显著（P = 0.005）但短暂的下降，与 SVRI 略有升高相关（r = - 0.857，P < 0.001）。在无并发症纵隔镜检查的猪中，通过内镜按需充气导致中位数纵隔压力为 4.5 mmHg（范围 2.3-10.2 mmHg）。总体而言，经食管途径可以轻松识别纵隔和胸部结构。
NOTES 纵隔镜检查有发生意外气胸的实质性风险。否则，它会导致微不足道的血液动力学和肺变化。总之，在 NOTES 纵隔镜检查期间，必须密切监测气胸的存在。
