Uehara Hirofumi, Yasuda Atsushi, Kondo Hiroshi, Kawamura Masafumi
Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Department of Anesthesiology, Teikyo University School of Medicine, Tokyo, Japan.
Interact Cardiovasc Thorac Surg. 2017 Nov 1;25(5):836-838. doi: 10.1093/icvts/ivx138.
Thoracic surgeons frequently encounter early lung cancer showing a pure ground-glass nodule. Although thoracoscopic wedge resection is used extensively, it cannot be easily located for surgical procedures. Thoracoscopic ultrasonography is a real-time and less invasive technique for small lung lesion localization during thoracoscopic surgery. However, this technique has not been widely adopted because residual air in the lung results in poor ultrasound images. A 64-year-old woman was found to have pure ground-glass nodule. For intraoperative localization, we performed thoracoscopic ultrasonography. To deflate the lung, we insufflated carbon dioxide into the thoracic cavity and maintained an intrathoracic pressure of 10 mmHg for 5 min. We easily achieved complete lung collapse without any complications; pure ground-glass nodule clearly showed as a hyperechoic lesion. We performed thoracoscopic wedge resection with a pathological diagnosis of adenocarcinoma in situ. Carbon dioxide insufflation into the thoracic cavity may be effective for complete lung deflation, which is useful to detect small lung nodules.
胸外科医生经常会遇到表现为纯磨玻璃结节的早期肺癌。尽管胸腔镜楔形切除术被广泛应用，但在手术过程中它不易定位。胸腔镜超声检查是一种在胸腔镜手术期间对小肺病变进行定位的实时且侵入性较小的技术。然而，由于肺内残留空气导致超声图像不佳，该技术尚未得到广泛应用。一名64岁女性被发现有纯磨玻璃结节。为了术中定位，我们进行了胸腔镜超声检查。为使肺萎陷，我们向胸腔内注入二氧化碳，并将胸腔内压力维持在10 mmHg 5分钟。我们轻松实现了完全肺萎陷且无任何并发症；纯磨玻璃结节清晰显示为高回声病变。我们进行了胸腔镜楔形切除术，病理诊断为原位腺癌。向胸腔内注入二氧化碳可能对实现完全肺萎陷有效，这有助于检测小肺结节。
