支气管封堵器在左侧肺叶切除术后行右侧肺部分切除术患者肺隔离中的临床应用

Clinical analysis of bronchial blocker used for lung isolation in patients undergoing right lung partial resection after left lobectomy

目的:探讨左侧肺叶切除术后行右侧肺部分切除术患者的临床特征及肺隔离方法效果。方法:选取2022年5月至2023年11月首都医科大学附属北京友谊医院胸外科收治的5例行左侧肺叶切除术后再行右侧肺部分切除术的患者。术前评估患者胸部CT除外下呼吸道解剖异常,全麻诱导后使用单腔气管插管联合支气管封堵器行肺隔离,采用短暂停通气结合术侧肺阻塞技术行单肺通气。术中均采用保护性肺通气策略,观察肺隔离成功、单肺通气时高气道峰压、低氧血症发生情况及处理方法。结果:5例患者均无右肺上叶开口解剖变异,使用支气管封堵器行肺隔离完成手术治疗,其中2例患者行右肺隔离,2例患者行选择性右肺上叶隔离,1例患者行选择性右肺中下叶隔离。2例行选择性右肺上叶隔离患者中,1例患者需降低单肺通气时潮气量以利于右肺上叶的显露。另1例单肺通气后出现高气道峰压,调整呼吸模式后未见好转且脉搏血氧饱和度进行性下降,在窒息氧合下完成肿物切除。5例患者单肺通气时均未发生低氧血症,术后随访均无麻醉并发症。结论:支气管封堵器可安全用于左侧肺叶切除术后再次行右肺部分切除手术患者的肺隔离,但术前应仔细评估右肺上叶开口位置是否存在变异,选择合理的肺隔离方案,并有相应处理预案。

Objective:To investigate the clinical characteristics and lung isolation methods of patients who underwent right lung partial resection after left lobectomy.Methods:A total of 5 patients who underwent right lung partial resection after left lobectomy in Department of Thoracic Surgery of Beijing Friendship Hospital from May 2022 to November 2023 were selected.The chest CT of patients was assessed before surgery to rule out anatomic abnormalities of the external lower respiratory tract.After induction of general anesthesia,a single-lumen endotracheal intubation combined with a bronchial blocker was used to undergo lung isolation,and a short apnea combined with surgical side pulmonary obstruction technique was used to perform one-lung ventilation.Protective lung ventilation strategy was used during the operation,and the success of lung isolation,high airway peak pressure during one-lung ventilation and the occurrence and treatment of hypoxemia of patients were observed.Results:There was no anatomical variation in the opening of the upper lobe of the right lung in all 5 patients.The surgical treatment was completed by using a bronchial blocker to perform lung isolation.Among them,2 patients underwent isolation for right lung,and 2 patients underwent selective isolation for upper lobe of right lung,and 1 patient underwent selective isolation for middle and lower lobes of right lung.In the 2 patients who underwent selective isolation for upper lobe of right lung,1 patient needed to reduce the tidal volume during one-lung ventilation so as to facilitate the exposure of the upper lobe of right lung,and another occurred high airway peak pressure after one lung completed ventilation,which did not been improved after adjusted the breathing mode,and whose pulse oxygen saturation progressively decreased,and whose tumor was resected under apneic oxygenation.None of the 5 patients occurred hypoxemia during ventilation with one-lung,and there were no anesthetic complications in postoperative follow-up.Conclusion:The bronchial blocker can be safely used in isolation for lung of patients who again undergo right lung partial resection after left lobectomy,while it is necessary to carefully assess whether there is variation in the opening position of the upper lobe of the right lung before surgery.A reasonable plan of lung isolation should be selected,and corresponding treatment plans should be prepared.