Matsunari Yasunori, Kinouchi Keiko, Ono Rie, Haruna Junichi
Department of Anesthesia and Intensive Care, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi 594-1101.
Masui. 2010 Oct;59(10):1234-40.
With the increasing use of endoscopic surgery in children, several papers report the comparison between the thoracoscopic and open repair of the neonatal esophageal atresia with tracheoesophageal fistula (EA/TEF). Most of them focus on the duration and outcome of the surgery with few focusing on the neonatal tolerance to the thoracoscopic procedure and intraoperative anesthetic management.
We retrospectively reviewed the repair surgery of EA/TEF performed during 2001 and 2006 in our institution and compared thoracoscopic repair (thoracoscopy group, n=5) with open repair (open group, n=7). The right main bronchus was blocked with Fogarty catheter in thoracoscopic repair, but not in open repair. Thoracoscopic repair was performed with insufflation of carbon dioxide (3-5 mmHg).
The thoracoscopy group had a higher incidence of intraoperative hypercapnia and acidosis and required higher inspired oxygen fraction. On admission to ICU Pa(CO2) was in the normal range in both groups and there was no difference in the duration of mechanical ventilation and ICU stay.
Hypercapnia and acidosis were severer in thoracoscopy group. Careful perioperative adjustment of inspired oxygen fraction and ventilator setting is required.
随着儿童内镜手术应用的增加，多篇论文报道了新生儿食管闭锁合并气管食管瘘（EA/TEF）胸腔镜修复术与开放修复术的比较。其中大多数关注手术时长和结果，很少关注新生儿对胸腔镜手术的耐受性及术中麻醉管理。
我们回顾性分析了2001年至2006年在我院进行的EA/TEF修复手术，并将胸腔镜修复术（胸腔镜组，n = 5）与开放修复术（开放组，n = 7）进行比较。胸腔镜修复术中用Fogarty导管阻塞右主支气管，开放修复术中则不阻塞。胸腔镜修复术通过二氧化碳充气（3 - 5 mmHg）进行。
胸腔镜组术中高碳酸血症和酸中毒的发生率更高，且需要更高的吸入氧分数。入住重症监护病房（ICU）时两组的动脉血二氧化碳分压（Pa(CO2)）均在正常范围内，机械通气时长和ICU住院时间无差异。
胸腔镜组的高碳酸血症和酸中毒更严重。围手术期需要仔细调整吸入氧分数和呼吸机设置。
