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既往行肺叶切除术患者择期腹腔镜胆囊切除术的麻醉考量

Anesthetic Considerations for Elective Laparoscopic Cholecystectomy in a Patient With Previous Pneumonectomy.

作者信息

Kumar Sharad, Uppalapati Vamsi Krishna, Shukla Rajiv, Chattoraj Ashok

机构信息

Anaesthesiology, Tata Main Hospital, Jamshedpur, IND.

General Surgery, Tata Main Hospital, Jamshedpur, IND.

出版信息

Cureus. 2022 Feb 13;14(2):e22176. doi: 10.7759/cureus.22176. eCollection 2022 Feb.

Abstract

Patients presenting for surgery after pneumonectomy pose significant challenges to anesthesiologists. The disease process necessitating pneumonectomy may involve the surviving lung too. Cholecystectomy is a major surgery, and the open approach has significant risks of post-operative pulmonary complications in these patients partly owing to the large incision and postoperative atelectasis, associated with inadequate post-operative analgesia. Contemplating a laparoscopic procedure in patients with a single, possibly damaged lung, involves a good understanding of the physiology of the single lung as well as the challenges posed by capnoperitoneum. Here, we present a case of a female with a history of previous pneumonectomy undergoing laparoscopic cholecystectomy. There are very few reports of patients after pneumonectomy who have subsequently undergone a laparoscopic cholecystectomy successfully and this report highlights some crucial factors to be kept in mind during anesthetic management of such patients.

摘要

肺切除术后接受手术的患者给麻醉医生带来了重大挑战。需要进行肺切除术的疾病过程可能也累及健侧肺。胆囊切除术是一项大型手术,开放手术方式在这些患者中具有较高的术后肺部并发症风险,部分原因是切口大以及术后肺不张,且与术后镇痛不足有关。对于仅有一侧可能受损肺的患者考虑行腹腔镜手术,需要充分了解单肺的生理情况以及气腹带来的挑战。在此,我们报告一例有肺切除病史的女性患者接受腹腔镜胆囊切除术的病例。肺切除术后患者随后成功接受腹腔镜胆囊切除术的报道极少,本报告强调了在此类患者麻醉管理过程中需要牢记的一些关键因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8ae5/8923311/7d9a2e3c5d64/cureus-0014-00000022176-i01.jpg

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