摘要
患者取全身麻醉双腔气管插管,健侧折刀卧位,健肺机械通气.以腋前线第 4 肋间 3.0 cm切口作为操作孔,第 7 肋间 1 cm切口作为观察孔,采用欧普迪曼胸腔镜荧光成像系统,根据患者术前薄层CT数据,实施手术规划,拟行左上肺固有段切除.术中准确辨识并离断固有段静脉、固有段各分支动脉及固有段支气管,注意保护段间静脉,其后胸腔镜调为荧光模式,将 25 mg吲哚菁绿溶于 10 mL生理盐水中,巡回护士取 2 mL注入外周静脉,注入的吲哚菁绿可与血液中存在的血浆蛋白结合,发出波长为(780～805)nm的荧光,而荧光胸腔镜系统中特制的荧光灯[(700～900)nm]可准确辨识此波长,显示出一绿色荧光染色平面,即为:段间交界面(靶段组织因血管离断后荧光剂无法进入,因而荧光模式下未染色),标记交界面,使用能量器械协助游离段门,利用肺切割缝合器裁剪段间平面,完成左上肺固有段切除,根据术中冰冻病理结果,采样/清扫肺门、纵隔淋巴结,术后经操作孔及观察孔放置胸管两根.
Abstract
The patient underwent general anesthesia with double lumen endotracheal intubation during the operation.The healthy side was placed in the prone jackknife position,and the healthy side was mechanically ventilated.Using a 3.0 cm incision in the fourth intercostal space of the axillary line as the operating hole and a 1 cm incision in the seventh intercostal space as the observation hole,the Opdiman thoracoscopic fluorescence imaging system was used.Based on the patient's preoperative thin-layer CT data,the current surgical plan was implemented to accurately identify and isolate the target segment veins,arteries and bronchi,focusing on protecting the inter-segment veins.Afterwards,the thoracoscope was switched to fluorescence mode.The circulating nurse dissolved 25 mg indocyanine green in 10 mL of physiological saline,of which 2 mL(equivalent to 5 mg indocyanine green)was injected through the peripheral vein.Indocyanine green combined with plasma proteins in the blood,emitting fluorescence with a wavelength of(780-805)nm.The fluorescence lamp specially designed for thoracoscopy[(700-900)nm]was used,effectively identifying this wavelength and displaying a green fluorescent staining plane,which was the interface between segments(the target segment tissue couldnot be stained in fluorescence mode due to the inability of fluorescent agents to enter after vascular detachment).The interface was marked,the segment gate was freed with energy instruments,the plane between segments was cut using a lung cutting stapler,and the resection of the intrinsic segment of the left upper lung was completed.Based on the intraoperative frozen pathological results,the pulmonary hilum and mediastinal lymph nodes were sampled and cleaned.After surgery,two thoracic tubes were placed through the operating hole and observation hole.
NETL
NSTL
万方数据