Between March, 2016 and January, 2017, 53 patients underwent robotic-assisted esophagectomy with triple incisions. All the patients were intubated with Double lumen endotracheal tub with one-lung ventilation and CO2 pneumoperitoneum, and CO2 pneumothorax was used in 7 cases. Most of the patients could tolerate OLV and CO2 pneumoperitoneum, and 4 patients with CO2 pneumothorax had hypoxemia and required double-lung ventilation or high frequency ventilation; 15 patients developed postoperative pulmonary complications and were transferred to ICU. These results suggest that CO2 pneumothorax during robotic-assisted esophagectomy with triple incision seriously disturbs pulmonary function, and careful anesthesia management is essential for preventing complications.
达芬奇机器人辅助下食管癌三切口手术患者53例，全麻诱导后插入左双腔支气管导管，胸腔部手术时单肺通气（OLV），上腹部手术时CO2气腹，其中7例OLV时行CO2气胸。监测术中血氧、呼吸力学及血流动力学变化。多数病人能耐受OLV及CO2气腹，7例OLV时行CO2气胸患者中，4例出现SpO2低于90%，需要间断双肺通气或停止气胸；OLV及CO2气腹引起的血流动力学紊乱通过血管活性药予纠正；术后发生需入ICU治疗的肺部并发症15例，住院期间无死亡病例。机器人食管癌三切口手术的麻醉管理对麻醉医师有较高的要求，麻醉医师与术者之间的团队配合对手术成功十分重要。