Ono Akihiro, Nakamura Masaki, Hayashi Tomoe, Tsuru Ibuki, Izumi Taro, Kusakabe Masashi, Nakao Kazunari, Kashiwagi Masanori, Kume Haruki, Shiga Yoshiyuki
Department of Urology NTT Medical Center Tokyo Tokyo Japan.
Department of Anesthesiology NTT Medical Center Tokyo Tokyo Japan.
IJU Case Rep. 2023 Sep 25;6(6):461-464. doi: 10.1002/iju5.12648. eCollection 2023 Nov.
Subcutaneous emphysema is a relatively common complication in laparoscopic surgery. However, airway obstruction secondary to subcutaneous emphysema is rare.
A 63-year-old woman with a 56-mm left renal tumor underwent a robot-assisted partial nephrectomy. The operative time was 155 min, the insufflation time was 108 min, and the estimated blood loss was 70 mL. The pneumoperitoneum pressure was maintained at 12 mmHg, except at 15 mmHg for 19 min during tumor resection. The end-tidal CO was <47 mmHg throughout the procedure. Postoperatively, broad subcutaneous emphysema from the thigh to the eyelid was observed. Computed tomography revealed airway obstruction, and extubation was aborted. On postoperative day 1, emphysema around the trachea and neck improved and the intubation tube was successfully removed.
Both laryngeal emphysema and physical compression secondary to emphysema can cause airway obstruction. To reduce gas-related complications, the risk of developing subcutaneous emphysema should be properly assessed during robot-assisted laparoscopic surgery.
皮下气肿是腹腔镜手术中较为常见的并发症。然而，继发于皮下气肿的气道梗阻却较为罕见。
一名63岁女性，患有56毫米的左肾肿瘤，接受了机器人辅助的部分肾切除术。手术时间为155分钟，气腹时间为108分钟，估计失血量为70毫升。气腹压力维持在12毫米汞柱，肿瘤切除期间有19分钟维持在15毫米汞柱。整个手术过程中呼气末二氧化碳分压均<47毫米汞柱。术后，观察到从大腿至眼睑出现广泛的皮下气肿。计算机断层扫描显示气道梗阻，拔管中止。术后第1天，气管和颈部周围的气肿有所改善，气管插管成功拔除。
喉气肿和气肿继发的物理压迫均可导致气道梗阻。为减少与气体相关的并发症，在机器人辅助腹腔镜手术期间应正确评估发生皮下气肿的风险。
