Tension Pneumothorax during One-lung Ventilation for Video-assisted Thoracoscopic Surgery (VATS) Using a Single-incision Subxiphoid Approach for Bilateral Lung Tumor Resection

經劍突下單孔胸腔鏡雙側肺腫瘤切除手術於單肺通氣時併發張力性氣胸

陳柏亨(Po-Heng Chen) ； 蕭斯云(Szu-Yun Hsiao) ； 王瑞琪(Juei-Chii Wang) ； 汪志雄(Chih-Shung Wong) ； 李欣恩(Sing-Ong Lee)

《輔仁醫學期刊》 15卷1期 (2017/03) Pp. 19-24

https://doi.org/10.3966/181020932017031501003

摘要

Traditionally, up to six incisions are required for video-assisted thoracoscopic surgery (VATS) for bilateral lung tumor resection. Besides, change posture was required during operation. In this case report, a single-incision subxiphoid approach was used for VATS to shorten operation time and reduce postoperative pain; this approach may also lead to better cosmetic results. However, in the described case, after a right-side tumor was removed, an episode of desaturation due to right-side tension pneumothorax was observed during one-lung ventilation for left lung tumor resection. CO2 insufflation was ceased, and the patient's condition improved. A literature review and suggestions for future similar surgeries are discussed.

關鍵字

Single-incision subxiphoid approach video-assisted thoracoscopic surgery ； Desaturation ； Tension pneumothorax ； Lung tumor resection ； One lung ventilation ； Anesthesia

並列摘要

傳統上，使用胸腔鏡做雙側肺腫瘤切除手術，需要切開六個傷口，並於術中換位，而我們這位病人，經由劍突下切開一個傷口而完成手術，不僅不需換位，也可縮短手術時間，術後疼痛較少，在傷口的美觀上也比較理想。然而，在手術當中，外科醫師切下右肺腫瘤後，於單肺通氣下進行左邊肺腫瘤切除時，病人發生右側張力性氣胸，血氧下降，在停止灌二氧化碳到胸腔以後情況改善。我們回顧相關文獻，並且探討未來進行類似的手術時的處置流程與注意事項。

並列關鍵字

經劍突下單孔胸腔鏡手術 ； 缺氧 ； 張力性氣胸 ； 肺腫瘤切除 ； 單肺通氣 ； 麻醉