Dion Y M, Lévesque C, Doillon C J
Department of Surgery, Laval University, St-François d'Assise Hospital, Quebec, Canada.
Surg Endosc. 1995 Oct;9(10):1065-9. doi: 10.1007/BF00188988.
The potential for pulmonary embolization following major venous laceration occurring during laparoscopic surgery has never been evaluated. Five anesthetized dogs were hemodynamically monitored with an arterial line and Swan-Ganz catheter. Observation by transesophageal echocardiography (TEE) allowed comparison with pulmonary artery pressure (PAP) recording. Under pneumoperitoneum, a 1-cm venotomy was performed in the infrarenal vena cava and a total of 11 events were evaluated upon unclamping the venotomy. These results were compared with intravenous (i.v.) bolus injections of 15 cc of CO2 (15 events) and of 100 cc of CO2 (12 events). The animals were maintained euvolemic. In 2 out of the 11 (18%) events which followed unclamping the venotomies, a few CO2 bubbles were seen in the right heart cavities. However, the quantity of gas was much less important than that seen after i.v. injection of 15 cc and 100 cc of CO2. There was no significant elevation of the PAP from pre-event values after venotomy or after i.v. injection of 15 cc of CO2. However, there was a significant difference (P < 0.05) when these results were compared to the PAP values recorded after i.v. injection of 100 cc of CO2. No dog died after these episodes of embolization. Massive i.v. injection of CO2 (> 300 cc) led to appearance of gas bubbles in the left heart cavities and death. This experiment suggests that caution should be exerted when laparoscopic surgery is performed beside large veins. Nevertheless, the observation that no gas embolism occurred in 82% of the cases after unclamping venotomies was unexpected. In contrast, many more gas bubbles were detected in the right heart after i.v. injection of only 15 cc of CO2. TEE is a more sensitive indicator of pulmonary embolization than elevation of PAP.
腹腔镜手术期间发生的主要静脉撕裂后发生肺栓塞的可能性从未得到评估。对五只麻醉犬通过动脉导管和 Swan-Ganz 导管进行血流动力学监测。经食管超声心动图（TEE）观察可与肺动脉压（PAP）记录进行比较。在气腹状态下，在肾下腔静脉进行 1 cm 的静脉切开术，并在松开静脉切开术夹后评估了总共 11 次事件。将这些结果与静脉推注 15 cc CO₂（15 次事件）和 100 cc CO₂（12 次事件）进行比较。动物维持血容量正常。在松开静脉切开术夹后的 11 次事件中有 2 次（18%），在右心腔中可见少量 CO₂气泡。然而，气体量比静脉注射 15 cc 和 100 cc CO₂后所见的要少得多。静脉切开术后或静脉注射 15 cc CO₂后，PAP 与事件前值相比无显著升高。然而，将这些结果与静脉注射 100 cc CO₂后记录的 PAP 值进行比较时，存在显著差异（P < 0.05）。这些栓塞事件后没有犬死亡。大量静脉注射 CO₂（> 300 cc）导致左心腔出现气泡并死亡。该实验表明，在大静脉旁进行腹腔镜手术时应谨慎。然而，松开静脉切开术夹后 82%的病例未发生气体栓塞这一观察结果出乎意料。相比之下，仅静脉注射 15 cc CO₂后，右心检测到的气泡更多。与 PAP 升高相比，TEE 是肺栓塞更敏感的指标。
