Objective: To investigate the effect of the single lumen endobronchial tube and the double lumen endobronchial tube on ventilation and lung injury in patients with esophageal cancer undergoing combined thoracoscopic and laparoscopic esophagectomy. Methods: Sixty patients with esophageal cancer undergoing combined thoracoscopic and laparoscopic esophagectomy were divided into single lumen endobronchial tube group (D group, n=30) and double lumen endobronchial tube group (S, n=30) according to the random number table. Blood samples were harvested at the moment of tracheal intubation (T(0)), after artificial pneumothorax (one lung ventilation) 30 min (T(1)), after artificial pneumothorax (one lung ventilation) 90 min (T(2)), artificial pneumothorax over (double lung ventilation) 30 min (T(3)) and after extubation 30 min (T(4)) for arterial blood gas analysis. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO(2)), oxygen tension (PaO(2)), carbon dioxide partial pressure (PaCO(2)) and airway pressure (PAW) were recorded at T(0)-T(4). The incidences of pneumonia of two groups were record at 3 days after operation. Results: There were no obvious differences in HR, MAP, SpO(2), PaO(2), PaCO(2) between two groups at T(0)-T(4) (P>0.05). Compared with T(0), the levels of HR and PaO(2) were increased remarkably at T(1)-T(3) (P<0.05), the levels of PaCO(2) were increased remarkably at T(1)-T(4) (P<0.01), and the levels of Paw were increased remarkably at T(1)-T(3) (P<0.01). Compared with S group, the levels of Paw were decreased remarkably at T(1)-T(2) (29.5±3.7 vs 21.3±2.1, P=0.001; 30.7±4.8 vs 20.3±2.3, P=0.001). There were no obvious differences in the levels of TNF-α, IL-6, IL-8 in Bronchoalveolar Lavage Fluid (BALF) between two groups at T(0) (P>0.05). Compared with T(0), the levels of TNF-α, IL-6, IL-8 in BALF were increased remarkably at T(3), T(5) (P<0.05). Compared with S group, the levels of TNF-α, IL-6, IL-8 in D group in BALF were decreased remarkably at T(3), T(5) (P<0.05). Compared with S group, the incidence of pneumonia in D group were decreased remarkably at 3 days after operation (4(13.3%) vs 11(36.7%), P=0.017). Conclusion: The ventilation effect of the single lumen endobronchial tube on lung injury for patients with esophageal cancer undergoing combined thoracoscopic and laparoscopic esophagectomy is the same as that of the double lumen endobronchial tube, however the single lumen endobronchial tube has less injury on the lung.
目的： 观察单腔、双腔气管插管对胸腹腔镜食管癌根治术通气效果及肺损伤的影响。 方法： 择期全麻下行胸腹腔镜食管癌根治术患者60例，利用随机数字表法分为单腔气管插管组(D组)和双腔气管插管组(S组)，各30例。采集患者气管插管完成即刻(T(0))、人工气胸后(单肺通气)30 min(T(1))、人工气胸后(单肺通气)90 min(T(2))、人工气胸结束后(双肺通气)30 min(T(3))、拔管后30 min(T(4))的动脉血，监测动脉血气；记录各个时间点的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO(2) )、血氧分压(PaO(2) )、血二氧化碳分压(PaCO(2))及气道压(Paw)。采集患者T(0)、T(3)、手术结束(T(5))支气管肺泡灌洗液(BALF)，应用酶联免疫吸附法(ELISA)检测BALF中TNF－α、IL－6、IL－8的水平。记录两组患者术后3 d肺炎发生率。 结果： T(0)～T(4)时两组患者HR、MAP、SpO(2)、PaO(2)、PaCO(2)差异无统计学意义(P>0.05)；与T(0)时相比，T(1)～T(3)时两组患者HR明显升高(P<0.05)，T(1)～T(3)时两组患者PaO(2)明显升高(P<0.05)，T(1)～T(4)时两组患者PaCO(2)明显升高(P<0.01)，T(1)～T(3)时两组患者Paw明显升高(P<0.01);与S组相比，T(1)～T(2)时D组患者Paw明显降低(29.5±3.7比21.3±2.1，P＝0.001; 30.7±4.8比20.3±2.3，P＝0.001)。T(0)时两组患者BALF中TNF－α、IL－6、IL－8水平差异无统计学意义(P>0.05)；与T(0)时相比，T(3)、T(5)时两组患者BALF中TNF－α、IL－6、IL－8的水平明显升高(P<0.05)；与S组相比，T(3)、T(5)时D组患者BALF中TNF－α、IL－6、IL－8的水平明显降低(P<0.05)。与S组相比、D组术后3 d胸片显示肺炎发生率明显降低[4例(13.3%)比11例(36.7%), P＝0.017]。 结论： 单腔、双腔气管插管在胸腹腔镜食管癌根治术中都可以产生满意的通气效果，但是单腔气管插管对肺损伤影响更小。.
Keywords: Combined thoracoscopic and laparoscopic esophagectomy; Esophageal cancer; Inflammatory factors; Lung.