腹腔镜肝切除术围手术期经食管超声心动图检测异位二氧化碳气体栓塞伴卵圆孔未闭1例。

Anesthesia and pain medicine Pub Date : 2022-10-01 Epub Date: 2022-10-19 DOI:10.17085/apm.22170
Haesoo Kim, Jeongyoon Lee, Sang-Gon Lee, Kwang-Seok Shim
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引用次数: 0

摘要

背景:由于腹腔镜手术的各种优点,在需要肝切除术的患者中,腹腔镜手术优于剖腹手术。二氧化碳栓塞——在腹腔镜肝切除术中发生的频率大约是普通腹腔镜手术的十倍——表现为不明显的症状,可能被忽视。病例:一位70岁男性肝癌患者行腹腔镜肝切除术。虽然他的生命体征在手术开始时是稳定的,但在手术过程中变得不稳定。外科医生发现门静脉破裂,随后进行了经食管超声心动图检查。我们观察到由于右至左分流引起的心腔内大量气体和通过卵圆孔未闭的矛盾栓塞。我们治疗了症状,手术完成了,没有任何进一步的问题。结论:在疑似二氧化碳栓塞时积极使用经食管超声心动图识别和监测心功能可以显著降低栓塞相关的发病率和死亡率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Detection of paradoxical carbon dioxide gas embolism with opening of patent foramen ovale by perioperative transesophageal echocardiography during laparoscopic hepatectomy - A case report.

Detection of paradoxical carbon dioxide gas embolism with opening of patent foramen ovale by perioperative transesophageal echocardiography during laparoscopic hepatectomy - A case report.

Detection of paradoxical carbon dioxide gas embolism with opening of patent foramen ovale by perioperative transesophageal echocardiography during laparoscopic hepatectomy - A case report.

Detection of paradoxical carbon dioxide gas embolism with opening of patent foramen ovale by perioperative transesophageal echocardiography during laparoscopic hepatectomy - A case report.

Background: Due to its various advantages, laparoscopic surgery is preferred over laparotomy in patients who require hepatic resection. Carbon dioxide embolism -which occurs approximately ten times more often in laparoscopic hepatectomy than in general laparoscopic surgery-presents with insignificant symptoms and may be overlooked.

Case: A 70-year-old male with hepatic cell carcinoma underwent laparoscopic hepatectomy. Though his vital signs were stable during the initiation of surgery, they became unstable during the procedure. The surgeon detected portal vein rupture, and transesophageal echocardiography was subsequently performed. A large amount of gas in the heart chamber and paradoxical embolism through a patent foramen ovale due to a right-to-left shunt were observed. We treated the symptoms, and the surgery was completed without any further issues.

Conclusions: Active use of transesophageal echocardiography to identify and monitor heart functions during a suspected carbon dioxide embolism can significantly reduce morbidity and mortality associated with that embolism.

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