Schragl E, Bigenzahn W, Donner A, Gradwohl I, Aloy A
Klinik für Anästhesie und Allgemeine Intensivmedizin, Universität Wien.
Anaesthesist. 1995 Jan;44(1):48-53. doi: 10.1007/s001010050132.
Surgery by three-dimensional (3D) endoscopy is being used routinely in abdominal surgery and, in special cases, in thoracic surgery; however, it has not been reported as being used in microlaryngeal surgery. METHODS. We inserted a 3-D endoscope into a jet laryngoscope and studied the pressure properties at the tip of the laryngoscope as well as intrapulmonary pressures while applying superimposed high-frequency jet ventilation. The studies were conducted initially using a lung simulator, and then in seven patients undergoing microlaryngeal surgery. RESULTS. Due to the rather large 3-D endoscope, the diameter of the jet laryngoscope was reduced by between 25.2% and 70.9%, depending on its size. The measurements on the lung simulator revealed that reduction of laryngoscope diameter leads to an increase in the following parameters: expiratory resistance, tidal volume, and peak inspiratory pressure. The mean FiO2 was 0.74 +/- 0.1; the mean paO2 was 169.2 +/- 80.4 mmHg; and the mean paCO2 was 40.9 +/- 2.4 mmHg. The mean airway pressure was 19 +/- 5.3 mmHg prior to insertion of the endoscope and 12.3 +/- 6.9 mmHg after insertion. The mean positive end-expiratory pressure values increased from 2 +/- 0.6 to 3.6 +/- 2.3 mmHg. Reduction of the working pressure resulted in restoration of the initial inspiratory pressures and tidal volumes. CONCLUSIONS. In the clinical application of 3-D endoscopy via a jet laryngoscope, it was possible to achieve sufficient ventilation, inspection of the surgical field, and performance of the surgical procedure. A CO2 laser was used without changing the ventilation regime. Although technical alterations would be desirable for its application to microlaryngeal surgery, it is presently possible to safely use the 3-D endoscope via the jet laryngoscope for microlaryngeal surgery, presenting the surgeon with new possibilities in voice-improving microsurgery of the larynx.
三维（3D）内镜手术已在腹部手术中常规使用，在特殊情况下也用于胸外科手术；然而，尚未有其用于显微喉镜手术的报道。方法。我们将3D内镜插入喷射喉镜中，研究了喉镜尖端的压力特性以及在应用叠加高频喷射通气时的肺内压力。研究最初使用肺模拟器进行，然后在7例接受显微喉镜手术的患者中进行。结果。由于3D内镜尺寸较大，喷射喉镜的直径根据其大小减少了25.2%至70.9%。在肺模拟器上的测量显示，喉镜直径减小会导致以下参数增加：呼气阻力、潮气量和吸气峰值压力。平均FiO2为0.74±0.1；平均paO2为169.2±80.4 mmHg；平均paCO2为40.9±2.4 mmHg。在内镜插入前平均气道压力为19±5.3 mmHg，插入后为12.3±6.9 mmHg。平均呼气末正压值从2±0.6增加到3.6±2.3 mmHg。工作压力降低导致初始吸气压力和潮气量恢复。结论。在通过喷射喉镜进行3D内镜的临床应用中，能够实现充分通气、手术视野检查和手术操作。在不改变通气方式的情况下使用了二氧化碳激光。尽管将其应用于显微喉镜手术需要进行技术改进，但目前通过喷射喉镜安全使用3D内镜进行显微喉镜手术是可行的，为喉显微手术改善嗓音为外科医生带来了新的可能性。
