摘要
二氧化碳(CO2)栓塞是腔镜手术特有的并发症,在常规的腹腔镜结直肠手术中罕见报道,并未引起外科医生的足够认识。经肛全直肠系膜切除术是近些年逐渐兴起的低位直肠癌保肛手术,尽管全球范围内例数并不多,但是已经陆续有CO2栓塞并发症的报道。一旦发生严重的CO2栓塞,病死率极高。经肛全直肠系膜切除术发生CO2栓塞的主要相关因素包括经肛气腹压力过高、空间狭小、前列腺或阴道壁血运丰富以及头低体位等。预防及治疗的关键是重视相关危险因素的控制,识别发生CO2栓塞的早期征象,采取积极有效的对症处理。降低经肛手术组的气腹灌注压力可减少CO2栓塞的发生。经食管超声心动图是监测静脉内CO2最敏感的方式,但很难在临床上常规开展。呼气末CO2分压的突然下降是早期发现CO2栓塞的重要征象。术中有可疑腔隙分辨不出是正常组织间隙还是血管腔时,可以减小或停止气腹,观察是否出现"泡沫征",若有则说明CO2进入静脉,应考虑静脉栓塞的风险。
Carbon dioxide embolization is a special complication of laparoscopic colorectal surgery.It is rarely reported in conventional laparoscopic colorectal surgery,and has not been well recognized by surgeons.Transanal total mesorectal excision(taTME)is an increasingly popular sphincter-preserving surgery for low rectal cancer in recent years.Although the number of cases worldwide is not large,carbon dioxide embolization after operation has been reported successively.Once serious carbon dioxide embolization occurs,the mortality is extremely high.The main related factors of carbon dioxide embolization in taTME include high pressure of pneumoperitoneum,narrow space,abundant blood supply of prostate and vaginal wall,Trendelenburg position,etc.The key of prevention and treatment is to pay attention to the control of related risk factors,identify the early signs of carbon dioxide embolism,and take active and effective symptomatic treatment.Reducing the pressure of pneumoperitoneum perfusion can reduce the occurrence of CO2 embolism.Transesophageal echocardiography is the most sensitive way to monitor intravenously CO2,but it is difficult to carry out in clinical practice.The sudden decrease of end expiratory CO2 partial pressure is an important sign of early detection of CO2 embolism.If there is a suspicious lacuna in the operation,it is possible to reduce or stop the pneumoperitoneum when it is unable to distinguish between normal tissue gap or vascular lumen.If the"bubble sign"is observed,CO2 may enter the vein.The risk of venous embolism should be considered.
作者
刘鼎盛
张宏
Liu Dingsheng;Zhang Hong(Department of Colorectal Tumor Surgery,Shengjing Hospital,China Medical University,Shenyang 110004,China)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2019年第12期1110-1114,共5页
Chinese Journal of Gastrointestinal Surgery
基金
辽宁省自然科学基金资助项目(20170540997)。
关键词
直肠肿瘤
经肛全直肠系膜切除术
二氧化碳栓塞
Rectal neoplasms
Transanal total mesorectal excision
Carbon dioxide embolism
