Department of Surgery, Teine Keijinkai Hospital, Sapporo, Japan.
Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan.
Asian J Endosc Surg. 2022 Jul;15(3):670-673. doi: 10.1111/ases.13049. Epub 2022 Mar 13.
Transanal total mesorectal excision is a relatively new approach for treating lower rectal cancer. Carbon dioxide embolism is a critical complication of this procedure. We report the case of a 69-year-old man with lower rectal cancer who underwent transanal total mesorectal excision followed by laparoscopic low anterior resection. He had a sudden intraoperative carbon dioxide embolism during the transanal mesorectal excision. During the ventral dissection of the rectum, end-tidal carbon dioxide and blood oxygen saturation suddenly decreased. We stopped the insufflation of carbon dioxide and suspended the procedure. There was no circulatory collapse, and the vital signs gradually recovered; therefore, we resumed the surgery approximately 30 minutes later and completed it without additional complications. Upon reviewing the video, we found a small injured vein that would aspirate carbon dioxide. These findings suggested that careful hemostasis is essential to prevent carbon dioxide embolus during transanal total mesorectal excision.
经肛门全直肠系膜切除术是治疗低位直肠癌的一种较新方法。二氧化碳栓塞是该手术的一个关键并发症。我们报告了一例 69 岁男性低位直肠癌患者，行经肛门全直肠系膜切除术联合腹腔镜低位前切除术。在经肛门直肠系膜切除术中，他突然发生术中二氧化碳栓塞。在直肠腹侧切开过程中，呼气末二氧化碳和血氧饱和度突然下降。我们停止了二氧化碳充气并暂停了手术。没有发生循环衰竭，生命体征逐渐恢复；因此，大约 30 分钟后我们恢复了手术，并且没有出现其他并发症。在查看视频时，我们发现了一条会吸入二氧化碳的小损伤静脉。这些发现表明，在经肛门全直肠系膜切除术中，仔细止血对于预防二氧化碳栓子至关重要。
