Lin Miao, Shen Yaxing, Wang Hao, Fang Yong, Qian Cheng, Xu Songtao, Ge Di, Feng Mingxiang, Tan Lijie, Wang Qun
Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
J Thorac Dis. 2018 Mar;10(3):1912-1918. doi: 10.21037/jtd.2018.01.150.
To investigate the feasibility and safety of two lung ventilation with artificial pneumothorax in minimally invasive esophagectomy (MIE) through a comparison with conventional one lung ventilation.
Eleven hundred and sixty-six patients with esophageal cancer, who underwent McKeown MIE in our center from February 2006 to December 2016, were studied retrospectively. Seven hundred and five patients who underwent one lung ventilation with double lumen endotracheal tube (DLET) were assigned to DLET group. Other 461 patients who underwent two lung ventilation with single lumen endotracheal tube (SLET) were assigned to SLET group. Clinical characteristics, surgical variables and complications were compared between two groups.
There were comparable patient characteristics in two groups. Surgical variables and complications were discussed between two groups. SLET group seemed to have shorter operative time, shorter postoperative hospital stay, and more harvested recurrent laryngeal nerve (RLN) lymph nodes than DLET group, which might be attributed to experienced surgeons. However, there were no significant differences of complications between two groups. Intraoperative clinical parameters were further studied. Before intubation and artificial pneumothorax, there were no significant differences between two groups, except diastolic blood pressure (DBP). With the application of artificial pneumothorax, patients in SLET group have obviously higher PO, PCO, and PetCO value, and slightly lower pH value and blood pressure during thoracic phase. After the thoracic phase, the changes induced by artificial pneumothorax in SLET group were gradually reversed and clinical parameters gradually return to normal level.
Two lung ventilation with artificial pneumothorax is a safe and feasible choice during MIE.
通过与传统单肺通气进行比较，探讨人工气胸双肺通气在微创食管癌切除术（MIE）中的可行性和安全性。
回顾性研究2006年2月至2016年12月在本中心接受McKeown MIE的1166例食管癌患者。705例接受双腔气管插管（DLET）单肺通气的患者被分配到DLET组。其他461例接受单腔气管插管（SLET）双肺通气的患者被分配到SLET组。比较两组的临床特征、手术变量和并发症。
两组患者特征具有可比性。对两组的手术变量和并发症进行了讨论。SLET组的手术时间似乎更短，术后住院时间更短，并且比DLET组收获的喉返神经（RLN）淋巴结更多，这可能归因于经验丰富的外科医生。然而，两组之间的并发症没有显著差异。对术中临床参数进行了进一步研究。在插管和人工气胸之前，除舒张压（DBP）外，两组之间没有显著差异。随着人工气胸的应用，SLET组患者在胸腔期的PO、PCO和PetCO值明显更高，pH值和血压略低。胸腔期后，SLET组人工气胸引起的变化逐渐逆转，临床参数逐渐恢复到正常水平。
人工气胸双肺通气在MIE期间是一种安全可行的选择。
