Use of Transesophageal Echocardiography for Evaluation of Resectability of Lung Cancer

運用食道超音波來評估肺癌切除的可能性

王國揚(Kuo-Yang Wang) ； 林重遠(Chung-Yuan Lin) ； 詹國泰(Jan Kuo-Tai) ； 羅瑗(Lo Yuan) ； 張晃宙(Huan-Jou Chang)

《Acta Anaesthesiologica Sinica》 32卷4期 (1994/12) Pp. 255-260

摘要

Background: When patients with lung cancer are to undergo surgical resection, chest x-ray and computed tomography (CT) are widely used for evaluation of staging and of the resectability of the lesion. Unfortunately, the above methods cannot always provide sufficient information about resectability and some patients undergo unnecessary operations. Transesophageal echocardiography (TEE) has opened a new window for viewing cardiac structure and function. By TEE, one can also image the surrounding tissues and great vessels under continuous monitoring. Materials and Methods: We pre-operatively applied the awake TEE method in twenty whose chest CT showed suspected invasion of the heart by the tumor. Results: Our experience showed the following: (1) TEE can clearly identify whether lung cancer has invaded the heart and/or great vessels and therefore avoiding unnecessary operation; (2) Two patients had tumor seen abutting epicardium and/or aorta without invasion (under continuous imaging). Two patients had tumor compressing the right and left atrium with intact but not invading pericardium, and underwent successful surgical resection. Conclusion: We concluded that it is useful to apply TEE preoperatively in evaluating the resectability of the lung cancer especially when a chest CT shows suspicion of local invasion of the heart and great vessels; thus unnecessary thoracotomy can be avoided.

關鍵字

Transesophageal echocardiography ； lung cancer

並列摘要

當得到肺癌的病人需要接受胸腔外科手術時，胸部X光和胸部電腦斷層是目前被廣汎運用於評估肺癌的範圍及是否可用外科手術來切除。但是上述的方法並没有辦法提供足夠的訊息，以致於某些病人接受了不可切除的胸腔外科手術。食道超音波可經由食道來連續性觀查心臟，大血管，及周邊組織，因此我們運用清醒食道超音波方法，在手術前來評估肺癌的範圍。在20個病人當中，皆是胸腔外科醫師在手術前從胸部電腦斷層看到肺癌靠近心臟或肺門，因此轉到麻醉科，在誘導室接受清醒食道超音波檢查。其中6個病例因爲食道超音波清楚顯示肺癌已侵犯到心臟或大血管，因此胸腔外科醫師同意病人没有接受胸腔手術的必要。只有14個病人接受胸腔手術。我們的經驗顯示出：（1）經由食道超音波，我們可以很清楚看見肺癌是否已侵犯到心臟或大血管，提供給胸腔外科醫師來避免不必要的手術；（2）有兩個病例在食道超音波上顯示肺癌只有接觸到心包膜或降主動脈，且有足夠空間來接紮肺動脈與肺靜脈，因此可進行肺切除或肺葉切除（胸部電腦斷層圖是建議此肺癌已侵犯心臟或主動脈而不適合開刀）。我們所得到的結論是在手術前運用食道超音波來評估肺癌切除的可能性，可與胸部電腦斷層圖相輔相成，可避免不必要無法開刀的手術。