右支气管封堵在微创食管切除中的临床研究

Clinical Study of the Right Bronchial Occluder in Minimally Invasive Esophagectomy

目的评价微创食管切除术中采用右支气管封堵及人工气胸下进行单侧肺通气的安全性及可行性。方法采用微创食管切除术治疗食管癌患者96例,其中双腔气管插管40例,单腔气管插管右侧支气管封堵56例,维持胸内压5～10 mmHg,监测心率有创动脉压(ABP)、脉搏血氧饱和度(SpO2)、气道压及呼气末分压(PetCO2)等呼吸循环指标和血气分析结果,观察在充气前后变化趋势。结果人工气胸后,患者心率、有创动脉压、脉搏血氧饱和度基本无变化,气道压及分压均有不同程度升高,血气值下降,停止充气后,检测指标均恢复至基础水平。所有病例均顺利完成微创食管切除术,术后双腔气管插管组有2例因误吸出现肺部并发症,余者均无肺部并发症发生,均顺利出院。结论在微创食管切除术中,维持胸内压5～10 mmHg下,采用单侧支气管封堵能增加手术显露效果且安全有效。与双腔插管相比,右侧支气管封堵建立人工气胸对患者的呼吸影响更小,更安全。

Abstract： Objective To assess the safety and feasibility of the right bronchial occluder and artificial pneumothorax in minimally invasive esophagectomy. Methods 96 patients with esophageal carcinoma under- went minimally invasive esophagectomy in our department during January 2009 to April 2012. Of them, 40 had double lumen tracheal intubation and 56 received single lumen tracheal intubation and the right bronchial occlu- der and artificial pneumothorax. Their HR, ABP, SpO2 and PetCO~ were monitored when the intrathoracic pres- sure was maintained at 5 - 10 mmHg before and after insufflation. Results No significant change was found in HR, ABP, and SpO2 of the patients after pneumothorax was induced. However, their airway pressure, Pet- CO2 and PCO2 were differently increased and their pH value was decreased, which returned to normal after in- sufflation was stopped. The operation was successful for all patients. No complication occurred in the lungs of all patients except in 2 patients due to mistaken aspiration. All patients were discharged from hospital smoothly. Conclusion It is safe and feasible of the right bronchial occluder and artificial pneumothorax for minimally in- vasive esophagectomy. And it can provide a better exposed field for lymphadenectomy, a smaller breath influence and a safer operation of the right bronchial occluder in single lumen trachea.