Rách phế quản trong phẫu thuật cắt thực quản nội soi ngực bụng: Vai trò của thán đồ trong gây mê hồi sức-Reference-Cited by-同舟云学术

Rách phế quản trong phẫu thuật cắt thực quản nội soi ngực bụng: Vai trò của thán đồ trong gây mê hồi sức

Published:2023-05-16 Issue:87 Volume: Page:
ISSN:1859-3895
Container-title:Journal of Clinical Medicine- Hue Central Hospital
language:en
Short-container-title:jcmhch

Author:

Lê Bình

Abstract

Cắt thực quản nội soi ngực bụng ngày nay đã trở thành một kỹ thuật thông thường được áp dụng rộng rãi trong phẫu thuật tiêu hóa. Phẫu thuật này được thực hiện tại BVTW Huế từ năm 2007 với nhiều ưu điểm như: tránh mở ngực lớn, giảm thiểu các biến chứng hô hấp nặng thời kỳ hậu phẫu; có thể áp dụng cho bệnh nhân có nguy cơ cao; tái lập lưu thông tiêu hoá vùng cổ, tránh được nguy cơ dò miệng nối gây viêm trung thất là nguyên nhân tử vong cao sau phẫu thuật...Tuy nhiên, kỹ thuật gây mê cho loại phẫu thuật này là khó, đòi hỏi người gây mê phải có chuyên môn và kinh nghiệm cũng như trang thiết bị theo dõi đầy đủ. Bài báo cáo này trình bày hai trường hợp rách phế quản trong thì nội soi cắt thực quản đoạn ngực, được phát hiện bởi ê kip gây mê. Chúng tôi bàn luận về vai trò của việc theo dõi phân áp CO2 cuối thì thở ra EtCO2 là một thông số hỗ trợ chẩn đoán quan trọng. Từ khóa: Rách phế quản, cắt thực quản nội soi ngực bụng, phân áp CO2 cuối thì thở ra, thán đồ. ABSTRACT BRONCHIAL TEAR DURING LAPARO - THORACOSCOPIC ESOPHAGECTOMY PROCEDURE - REPORT OF TWO CASES: ROLE OF CAPNOGRAPHY DURING ANESTHESIA Laparo - thoracoscopic esophagectomy which is widely used in gastrointestinal surgery has become a common procedure. This type of surgery had been performed in Hue Central Hospital since 2007 and shows many advantages such as avoiding large thoracotomy not creating the risk of serious respiratory complications in postoperative period, being applicable to high - risk patients; re - establishing digestive esophagus - stomach circulation in the neck region to avoid the risk of mediastinitis due to anastomotic leaks - one of the main cause of death after surgery... However, anesthetic technique for this type of surgery is difficult, requiring the anesthesiologist to have expertise, experience and adequate monitoring equipment. We present two cases of intraoperative bronchopleural fistula because of bronchial tear during laparo- thoracoscopic esophagectomy procedure, which was first identified by the anesthesia team. We discuss differential diagnoses including the role of end-tidal carbon dioxide monitoring EtCO2 as an aid to prompt diagnosis.

Publisher

Hue Central Hospital

Subject

General Medicine

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