Ninomiya Itasu, Okamoto Koichi, Fushida Sachio, Oyama Katsunobu, Kinoshita Jun, Takamura Hiroyuki, Tajima Hidehiro, Makino Isamu, Miyashita Tomoharu, Ohta Tetsuo
Department of Gastroenterological Surgery, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
Gen Thorac Cardiovasc Surg. 2017 Oct;65(10):587-593. doi: 10.1007/s11748-017-0816-7. Epub 2017 Aug 21.
Thoracoscopic esophagectomy (TE) is widely performed as a minimally invasive technique in the management of esophageal cancer. The aim of this study was to estimate the efficacy of intrathoracic carbon dioxide (CO) insufflation during TE in the left lateral position.
From January 2010 to April 2016, 58 patients with esophageal cancer underwent TE without intrathoracic CO insufflation (Group N) and 37 patients with esophageal cancer underwent TE with intrathoracic CO insufflation (Group C). The operation results and respiratory parameters during the thoracic procedure were compared in both groups.
A satisfactory surgical field was obtained by CO insufflation. There was no difference in the duration of the thoracic procedure or number of dissected mediastinal lymph nodes between the two groups. The amount of thoracic blood loss in Group C was significantly less than that in Group N (P < 0.05). Intrathoracic CO insufflation did not affect oxygenation during single-lung ventilation. However, both end-tidal CO (ETCO) 1 h after single-lung ventilation and maximum ETCO in Group C were significantly higher than those in Group N. Intraoperative hypercapnia in Group C was permissive. The rate of extubation in the operation room, mortality and morbidity were not different between the two groups.
Intrathoracic CO insufflation is beneficial to make satisfactory surgical field and to reduce thoracic blood loss in TE. Application of intrathoracic CO insufflation may contribute to the widespread adoption of TE in the left lateral position.
电视胸腔镜食管切除术（TE）作为一种微创手术在食管癌治疗中被广泛应用。本研究旨在评估左侧卧位TE术中胸腔内二氧化碳（CO）充气的效果。
2010年1月至2016年4月，58例食管癌患者接受了未进行胸腔内CO充气的TE（N组），37例食管癌患者接受了胸腔内CO充气的TE（C组）。比较两组手术结果及胸腔手术过程中的呼吸参数。
CO充气可获得满意的手术视野。两组胸腔手术时间及清扫纵隔淋巴结数量无差异。C组胸腔失血量明显少于N组（P<0.05）。胸腔内CO充气不影响单肺通气时的氧合。然而，C组单肺通气1小时后的呼气末CO（ETCO）及最高ETCO均明显高于N组。C组术中允许性高碳酸血症。两组在手术室拔管率、死亡率及发病率方面无差异。
胸腔内CO充气有利于在TE中获得满意的手术视野并减少胸腔失血量。胸腔内CO充气的应用可能有助于TE在左侧卧位的广泛应用。
