Hyodo S
First Department of Surgery, Kurume University School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Apr;41(4):625-37.
Eighteen dogs (8-21 kg) were anesthetized with pentobarbital sodium, buprenorphine and pancuronium bromide followed by endotracheal intubation in the supine position. Eighteen dogs were divided into two groups. Group 1 (n = 9) underwent thoracic esophagectomy with regional lymph nodes dissection under the right thoracotomy. Group 2 (n = 9) underwent the same manner of Group 1, and then left thoracotomy was additionally performed in the 5th intercostal space to completely dissect the left side mediastinal lymph nodes. During surgical procedure, lactated Ringer's solution (L-R) were continuously administered and Dextran 40 were given according to surgical bleeding. For postoperative fluid therapy, L-R were given at 4 ml/kg/hr under spontaneous breathing. Central venous pressure (CVP), pulmonary arterial pressure (PAP), pulmonary wedge pressure (PWP), mean arterial pressure (AP), heart rate (PR), cardiac output (CO), extravascular lung water (EVLW), blood gas, lung resistance (RL), dynamic lung compliance (CL) and colloid osmotic pressure (COP) were measured at preoperative phase and three days after surgery. Significant differences were found in the PaO2, Qs/Qt, respiratory index (RI) and the dosage of Dextran 40 between Group 1 and Group 2. There are no significant differences in the tracheal ischemic changes between the two groups, but peripheral atelectasis in Group 2 seemed to be severe as compared to that in Group 1. From these results, extended radical esophagectomy by bilateral thoracotomy approach for clinical cases seems to be possible under the exact indication and intensive perioperative care.
18只犬(体重8 - 21千克)用戊巴比妥钠、丁丙诺啡和泮库溴铵麻醉,随后仰卧位行气管插管。18只犬分为两组。第1组(n = 9)在右胸开胸下行胸段食管切除术并清扫区域淋巴结。第2组(n = 9)行与第1组相同的手术方式,然后在第5肋间额外行左胸开胸以完全清扫左侧纵隔淋巴结。手术过程中,持续输注乳酸林格氏液(L - R),并根据手术出血量给予右旋糖酐40。术后液体治疗时,自主呼吸下以4毫升/千克/小时的速度给予L - R。在术前阶段及术后三天测量中心静脉压(CVP)、肺动脉压(PAP)、肺楔压(PWP)、平均动脉压(AP)、心率(PR)、心输出量(CO)、血管外肺水(EVLW)、血气、肺阻力(RL)、动态肺顺应性(CL)和胶体渗透压(COP)。第1组和第2组之间在动脉血氧分压(PaO2)、分流率(Qs/Qt)、呼吸指数(RI)和右旋糖酐40用量方面存在显著差异。两组之间气管缺血性改变无显著差异,但与第1组相比,第2组的外周肺不张似乎更严重。从这些结果来看,在明确的适应证和精心的围手术期护理下,双侧开胸入路的扩大根治性食管切除术用于临床病例似乎是可行的。