Wang Qianyun, Yao Guoliang, Xu Hairong, Jiang Xuewei, Zhang Xiaoyin
Department of Thoracic Surgery, the Third Affiliated Hospital to Soochow University, Changzhou, China.
Department of Gastroenterology, the Third Affiliated Hospital to Soochow University, Changzhou, China.
Ann Palliat Med. 2020 Sep;9(5):3107-3114. doi: 10.21037/apm-20-804. Epub 2020 Aug 4.
In recent years, minimally invasive esophagectomy (MIE) has been used gradually in esophageal surgery. The application of CO2 aeration in minimally invasive surgeries, especially in laparoscopic surgery, has been very mature. However, the application of CO2 aeration in mediastinal esophagectomy is still in the exploration stage. This study was designed to investigate the safety of mediastinal CO2 aeration in the mediastinal esophagectomy.
A total of 15 pigs were used to construct an experimental animal model of mediastinal CO2 aeration. The effects of different inflation pressures on the circulatory respiratory function of pigs were studied by detecting the relevant physiological parameters. Heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) were monitored before ventilating CO2 (T0), and also monitored at 30 (T1), 60 (T2), 90 (T3) min after inflation and 30 min after deflation (T4). Arterial blood was collected for PaCO2, blood lactate concentration (cLac), PaO2/FiO2, SaO2, pH value, and cardiac output (CO) was measured by esophageal ultrasound.
The results of animal experiments showed that under 5-10 mmHg CO2 inflation pressure, circulation function indicators (CVP, MAP, HR, CO) and respiratory function indicators (PaCO2, cLac, PaO2/FiO2, SaO2, pH value) in pigs had no significant difference compared with the indicators before inflation; and under 15 mmHg CO2 inflation pressure, CVP, HR, PaCO2 and blood cLac increased, while MAP, CO, PaO2, SaO2 and pH values decreased. The visual field using mediastinoscopy under 15 and 10 mmHg CO2 inflation pressure was better than that under 5 mmHg CO2 inflation pressure.
Mediastinal esophagectomy with 5-10 mmHg CO2 inflation pressure has no significant effect on the circulation and respiratory function of the body. Compared with the conventional non-inflated transseptal esophageal cancer (EC) surgery, it can provide a better surgical vision and reduce the difficulty of the surgery.
近年来，微创食管切除术（MIE）已逐渐应用于食管手术。二氧化碳充气在微创手术，尤其是腹腔镜手术中的应用已经非常成熟。然而，二氧化碳充气在纵隔食管切除术中的应用仍处于探索阶段。本研究旨在探讨纵隔二氧化碳充气在纵隔食管切除术中的安全性。
共使用15头猪构建纵隔二氧化碳充气的实验动物模型。通过检测相关生理参数，研究不同充气压力对猪循环呼吸功能的影响。在二氧化碳通气前（T0）监测心率（HR）、平均动脉压（MAP）和中心静脉压（CVP），并在充气后30（T1）、60（T2）、90（T3）分钟以及放气后30分钟（T4）进行监测。采集动脉血检测PaCO2、血乳酸浓度（cLac）、PaO2/FiO2、SaO2、pH值，并通过食管超声测量心输出量（CO）。
动物实验结果表明，在5 - 10 mmHg二氧化碳充气压力下，猪的循环功能指标（CVP、MAP、HR、CO）和呼吸功能指标（PaCO2、cLac、PaO2/FiO2、SaO2、pH值）与充气前指标相比无显著差异；在15 mmHg二氧化碳充气压力下，CVP、HR、PaCO2和血cLac升高，而MAP、CO、PaO2、SaO2和pH值降低。在15和10 mmHg二氧化碳充气压力下使用纵隔镜的视野优于5 mmHg二氧化碳充气压力下的视野。
二氧化碳充气压力为5 - 10 mmHg的纵隔食管切除术对机体的循环和呼吸功能无显著影响。与传统的非充气经膈食管癌（EC）手术相比，它可以提供更好的手术视野并降低手术难度。
