Takada Jun, Araki Hiroshi, Mizutani Taku, Ozawa Noritaka, Sugiyama Tomohiko, Kubota Masaya, Ibuka Takashi, Shimizu Masahito
Dig Dis. 2019;37(2):93-99. doi: 10.1159/000492870. Epub 2018 Sep 11.
Pulmonary dysfunction often accompanies esophageal squamous cell carcinoma (SCC).
This study examined the use of carbon dioxide (CO2) insufflation and its safety during esophageal endoscopic submucosal dissection (ESD) while under conscious sedation.
ESD using CO2 insufflation (1.4 L/min) was performed in 102 consecutive esophageal SCC patients. Patients with a forced expiratory volume of 1.0 s/forced vital capacity (FEV1.0%) < 70% or a vital capacity < 80% were defined as having pulmonary dysfunction. Transcutaneous partial pressure of CO2 (PtcCO2) was recorded before, during, and after ESD.
A history of smoking was found in 90 patients (88%), while 43 patients (42%) had pulmonary dysfunction. No significant differences were found between the pulmonary dysfunction and normal groups for the baseline PtcCO2 before ESD, peak PtcCO2 during ESD, and median PtcCO2 after ESD. There was a significant correlation between the PtcCO2 elevation from baseline and the ESD procedure time (r = 0.32, p < 0.01), with the correlation for the pulmonary dysfunction group much stronger (r = 0.39, p < 0.05) than that for the normal group (r = 0.30, p < 0.01). Neither of the groups exhibited any differences for either the complication incidence or the hospital stay.
Although the use of CO2 insufflation during esophageal ESD under conscious sedation is safe with regard to the risk of complications, longer procedure times can potentially induce CO2 retention in patients with obstructive lung disease. Thus, it is necessary to both shorten the procedure times and perform CO2 monitoring.
肺功能障碍常伴随食管鳞状细胞癌（SCC）。
本研究探讨在清醒镇静下食管内镜黏膜下剥离术（ESD）期间二氧化碳（CO₂）吹入的应用及其安全性。
对102例连续性食管SCC患者进行使用CO₂吹入（1.4 L/分钟）的ESD。用力呼气量1.0秒/用力肺活量（FEV₁.₀%）<70%或肺活量<80%的患者被定义为有肺功能障碍。在ESD前、期间和之后记录经皮二氧化碳分压（PtcCO₂）。
90例患者（88%）有吸烟史，43例患者（42%）有肺功能障碍。在ESD前的基线PtcCO₂、ESD期间的峰值PtcCO₂和ESD后的中位PtcCO₂方面，肺功能障碍组与正常组之间未发现显著差异。从基线起PtcCO₂升高与ESD手术时间之间存在显著相关性（r = 0.32，p < 0.01），肺功能障碍组的相关性（r = 0.39，p < 0.05）比正常组（r = 0.30，p < 0.01）更强。两组在并发症发生率或住院时间方面均未显示出任何差异。
尽管在清醒镇静下食管ESD期间使用CO₂吹入在并发症风险方面是安全的，但较长的手术时间可能会在阻塞性肺病患者中诱发CO₂潴留。因此，有必要缩短手术时间并进行CO₂监测。
