両肺換気腹臥位食道切除の有用性と手術手順の工夫について

Efficacy and surgical procedures of artificial pneumothorax using two-lung ventilation in thoracoscopic prone-position esophagectomy

◆要旨：当院では2008年よりシングルルーメンチューブ（SLT）挿管による両肺換気下に腹臥位胸腔鏡下食道切除術を施行している．FloTrac Systemを用いた呼吸・循環動態の検討では，臨床上問題となるような呼吸・循環動態を認めなかったほか，P/F比244.4mmHgと良好な酸素化を認めた．腹臥位は側臥位に比べ非換気側肺のシャント血流量が増加する可能性があり，特に左側胸膜が開放され両側人工気胸となった際に，最も換気血流比が悪化する可能性がある．今回筆者らは両肺換気下の呼吸・循環動態を検討するとともに，SLTの柔軟性と腹臥位胸腔鏡下食道切除術の特性を考慮した手術手順について報告する．

　At our hospital, we have been performing artificial pneumothorax using two-lung ventilation-based prone position esophagectomy since 2008. Using the FloTrac system, no excessive respiratory and circulatory depressions were observed, and the average PF ratio in the artificial pneumothorax was 244.4mmHg. Prone position is associated with greater ventilation-perfusion imbalance than decubitus position, especially in the situation of bilateral artificial pneumothorax associated with left-sided mediastinal pleural openings. In the present study, we examined the efficacy of thoracoscopic esophagectomy for esophageal cancer, which was performed under two-lung ventilation in the prone position. We report our surgical procedures suited for this method.