Department of Thoracic and Cardiovascular Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea.
Surg Endosc. 2020 Jan;34(1):312-316. doi: 10.1007/s00464-019-06768-0. Epub 2019 Mar 28.
Although thoracoscopic surgery is commonly performed in patients with a pneumothorax and persistent air leak, it is still difficult to identify a definite air leak site during thoracoscopic surgery. The purpose of this study was to determine the safety, efficacy, and feasibility of intraoperative air leak site detection in spontaneous pneumothorax through low-pressure carbon dioxide (CO) insufflation during thoracoscopic surgery.
Of 54 patients who underwent thoracoscopic pneumothorax operations between March 2017 and March 2018, 22 pneumothorax patients underwent surgery for a persistent air leak. All patients were intubated with a single- or double-lumen endotracheal tube for general anesthesia. Three-port thoracoscopic surgery was performed, and CO was insufflated into the thoracic cavity at a pressure of 3-5 mmHg under two-lung ventilation to ensure visibility for video-assisted thoracoscopic surgery (VATS) and identification of the air leak site.
Air leak sites were identified in all but one patient under CO insufflation. No intraoperative or postoperative adverse effects associated with CO insufflation were observed. The operative time was 37.8 ± 14.9 min (range 20-66 min), and the chest tube was removed after an average 2.7 ± 0.7 postoperative days (range 2-4 days). Patients were discharged after an average 4.1 ± 0.9 postoperative days (range 3-6 days). Postoperative recurrence was confirmed in 3 patients during 12.0 ± 4.0 months (range 5-16 months) of follow-up.
A method to detect an air leak site during VATS for pneumothorax using low-pressure CO appears to be safe, effective, and feasible.
虽然胸腔镜手术常用于气胸和持续漏气的患者，但在胸腔镜手术中仍难以确定明确的漏气部位。本研究旨在确定在胸腔镜手术中通过低压二氧化碳（CO）充气来检测自发性气胸术中漏气部位的安全性、有效性和可行性。
在 2017 年 3 月至 2018 年 3 月期间，对 54 例行胸腔镜气胸手术的患者中，有 22 例气胸患者因持续漏气而接受手术。所有患者均采用单腔或双腔气管插管全身麻醉。行三孔胸腔镜手术，在双肺通气下向胸腔内注入 CO，压力为 3-5mmHg，以保证视频辅助胸腔镜手术（VATS）的可视性并确定漏气部位。
除 1 例患者外，所有患者在 CO 充气下均能识别出漏气部位。未观察到与 CO 充气相关的术中或术后不良反应。手术时间为 37.8±14.9min（范围 20-66min），胸腔引流管平均在术后 2.7±0.7d（范围 2-4d）后拔除。患者平均在术后 4.1±0.9d（范围 3-6d）出院。在 12.0±4.0 个月（范围 5-16 个月）的随访中，有 3 例患者术后复发。
在 VATS 治疗气胸时使用低压 CO 检测漏气部位的方法似乎是安全、有效和可行的。
