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目的初步探讨胸腹腔食管癌切除术中,建立人工气胸对呼吸、循环的影响,评价其安全性及可行性。方法2010年5月至2011年6月本院在人工气胸条件下采用胸腔镜联合腹腔镜食管癌切除术治疗食管癌患者80例,其中双腔气管插管60例、单腔气管插管20例。在充气流速3 L/min、维持胸内压6～8 mmHg的条件下,监测心率、有创动脉压(ABP)、脉搏血氧饱和度(SpO2)、气道压及呼气末CO2分压(PetCO2)等呼吸、循环指标和血气分析结果,观察其在CO2充气前、后的变化趋势。结果手术开始建立人工气胸后,患者的心率、有创动脉压(ABP)、脉搏血氧饱和度(SpO2)基本没有变化,气道压、PetCO2及CO2分压(PCO2)均有不同程度升高,血气pH值下降,停止充气后,检测指标均恢复至基础值水平。所有病例均顺利完成胸腹腔食管癌切除腔镜食管癌切除术,术后仅1例患者由于误吸出现肺部并发症,其余患者均无肺部并发症发生,所有患者均顺利出院。结论在胸腹腔镜下行食管癌切除术中,在充气流速3 L/min、胸内压维持6～8 mmHg,采用二氧化碳建立人工气胸条件下,其增加显露且安全、有效。与双腔插管相比,单腔插管建立人工气胸对患者的呼吸影响更小,更为安全。
Objective To investigate the effect of artificial pneumothorax on respiration and circulation in the resection of thoracic and abdominal esophageal cancer and evaluate its safety and feasibility. Methods From May 2010 to June 2011, 80 patients with esophageal cancer underwent thoracoscopic and laparoscopic esophageal resection under artificial pneumothorax. The double-lumen endotracheal intubation was performed in 60 cases, single-lumen endotracheal intubation in 20 cases . Heart rate, arterial pressure (ABP), pulse oxygen saturation (SpO2), airway pressure and end-tidal CO2 partial pressure were monitored under the condition of 3 L / min inflation and 6-8 mmHg thoracic pressure. (PetCO2) and other respiration, circulatory index and blood gas analysis results to observe its change before and after CO2 aeration. Results After the establishment of artificial pneumothorax, the patients’ heart rate, arterial pressure (ABP) and pulse oxygen saturation (SpO2) basically remained the same. The airway pressure, PetCO2 and partial pressure of CO2 (PCO2) , Blood gas pH decreased to stop inflated, the test indicators were restored to the baseline level. In all cases, laparoscopic esophageal resection of the thoracic and abdominal esophageal cancer was successfully performed. Only 1 patient developed pulmonary complications due to aspiration, and no pulmonary complications occurred in the remaining patients. All patients were successfully discharged. Conclusions In thoracoscopic and laparoscopic esophageal cancer resection, inflation rate of 3 L / min and intrathoracic pressure of 6 ~ 8 mmHg are maintained. It is safe and effective to establish an artificial pneumothorax by using carbon dioxide. Compared with double-lumen cannula, the establishment of artificial pneumothorax with single-lumen cannula has less impact on the patient’s breathing and is safer.