Clinical application of high frequency jet ventilation in stereotactic liver ablations - a methodological study.
Clinical application of high frequency jet ventilation in stereotactic liver ablations - a methodological study.
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DOI：
10.12688/f1000research.14873.1
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发表时间：
2018-01-01
期刊：
影响因子：
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通讯作者：
Harbut, Piotr
中科院分区：
文献类型：
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作者：
Galmen, Karolina;Freedman, Jacob;Harbut, Piotr
背景：计算机辅助导航在肝肿瘤热消融过程中，可能有助于纠正针的放置，提高经皮、腹腔镜和开放式干预的消融效果。在手术过程中使用高频喷射通气技术（HFJV）的潜在优势是将与呼吸相关的上腹部器官运动的幅度降至最低。本临床方法学试验的目的是确定在开放手术下立体定向导航消融肝转移瘤期间，HFJV是否比传统通气更少引起通气诱导的肝脏运动。方法：连续5例在全身异丙酚和瑞芬太尼麻醉下择期开放肝消融的患者纳入研究方案。在肿瘤的立体定向靶向过程中，选择HFJV进行术中肺通气。为了跟踪肝脏的运动，在肝脏表面放置一个刚性的标记屏蔽，并使用光学位置测量系统进行跟踪。测定HFJV和常规潮气量肺通气（TV）组标记盾的4D位置。在每个时间点，肝脏位移的大小计算为标记盾三维位置的平移分量与先前估计的平移运动质心之间的欧几里德距离。结果：HFJV患者平均欧氏肝位移为0.80 (0.10)mm， TV患者平均欧氏肝位移为2,90 (1.03)mm，在标准通气条件下最大位移可达12 mm （p=0.0001）。结论：HFJV是一种有价值的全麻醉下立体定向手术患者的肺通气方法。
Background: Computer-assisted navigation during thermal ablation of liver tumours, may help to correct needle placement and improve ablation efficacy in percutaneous, laparoscopic and open interventions. The potential advantage of using high frequency jet-ventilation technique (HFJV) during the procedure is by minimising the amplitude of respiration-related upper-abdominal organs movements. The aim of this clinical methodological trial was to establish whether HFJV would give less ventilatory induced liver movements than conventional ventilation, during stereotactic navigated ablation of liver metastases under open surgery. Methods: Five consecutive patients scheduled for elective, open liver ablation under general propofol and remifentanil anaesthesia were included in the study protocol. During the stereotactic targeting of the tumours, HFJV was chosen for intraoperative lung ventilation. For tracking of liver movement, a rigid marker shield was placed on the liver surface and tracked with an optical position measurement system. A 4D position of the marker shield was measured for HFJV and conventional tidal volume lung ventilation (TV). At each time point the magnitude of liver displacement was calculated as an Euclidean distance between translational component of the marker shield's 3D position and previously estimated centroid of the translational motion. Results: The mean Euclidean liver displacement was 0.80 (0.10) mm for HFJV and 2,90 (1.03) mm for TV with maximum displacement going as far as 12 mm on standard ventilation (p=0.0001). Conclusion: HFJV is a valuable lung ventilation method for patients undergoing stereotactic surgical procedures in general anaesthesia when reduction of organ displacement is crucial.