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Intraoperative air leak site detection in spontaneous pneumothorax through carbon dioxide insufflation during thoracoscopic surgery.

胸腔镜手术中通过二氧化碳吹入法检测自发性气胸的术中漏气部位。

  • 影响因子:3.18
  • DOI:10.1007/s00464-019-06768-0
  • 作者列表:"Kang DY
  • 发表时间:2020-01-01
Abstract

BACKGROUND:Although thoracoscopic surgery is commonly performed in patients with a pneumothorax and persistent air leak, it is still difficult to identify a definite air leak site during thoracoscopic surgery. The purpose of this study was to determine the safety, efficacy, and feasibility of intraoperative air leak site detection in spontaneous pneumothorax through low-pressure carbon dioxide (CO2) insufflation during thoracoscopic surgery. METHODS:Of 54 patients who underwent thoracoscopic pneumothorax operations between March 2017 and March 2018, 22 pneumothorax patients underwent surgery for a persistent air leak. All patients were intubated with a single- or double-lumen endotracheal tube for general anesthesia. Three-port thoracoscopic surgery was performed, and CO2 was insufflated into the thoracic cavity at a pressure of 3-5 mmHg under two-lung ventilation to ensure visibility for video-assisted thoracoscopic surgery (VATS) and identification of the air leak site. RESULTS:Air leak sites were identified in all but one patient under CO2 insufflation. No intraoperative or postoperative adverse effects associated with CO2 insufflation were observed. The operative time was 37.8 ± 14.9 min (range 20-66 min), and the chest tube was removed after an average 2.7 ± 0.7 postoperative days (range 2-4 days). Patients were discharged after an average 4.1 ± 0.9 postoperative days (range 3-6 days). Postoperative recurrence was confirmed in 3 patients during 12.0 ± 4.0 months (range 5-16 months) of follow-up. CONCLUSION:A method to detect an air leak site during VATS for pneumothorax using low-pressure CO2 appears to be safe, effective, and feasible.

摘要

背景: 虽然胸腔镜手术通常用于气胸和持续性漏气的患者,但在胸腔镜手术中仍然难以确定明确的漏气部位。本研究的目的是确定胸腔镜手术中通过低压二氧化碳 (CO2) 吹气检测自发性气胸术中漏气部位的安全性、有效性和可行性。 方法: 在 2017年3月至 2018年3月期间接受胸腔镜气胸手术的 54 例患者中,22 例气胸患者因持续漏气而接受手术。所有患者均采用单腔或双腔气管导管插管全身麻醉。进行了三孔胸腔镜手术, 在双肺通气下以 3-5 mmHg 的压力向胸腔内注入 CO2,以确保电视胸腔镜手术 (VATS) 的可视性和空气泄漏部位的识别。 结果: 在 CO2 吹入下,除 1 例患者外,所有患者均发现漏气部位。未观察到与 CO2 吹入相关的术中或术后不良反应。手术时间 37.8 ± 14.9 min (范围 20-66 min), 术后平均 2.7 ± 0.7 天 (范围 2-4 天) 拔除胸管。患者平均术后 4.1 ± 0.9 天 (范围 3-6 天) 出院。在 12.0 ± 4.0 个月 (范围 5-16 个月) 的随访中,3 例患者证实术后复发。 结论: 采用低压 CO2 检测 VATS 气胸漏气部位是安全、有效、可行的。

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