1、經皮心肺支持第1頁，共12頁，2022年，5月20日，18點41分，星期二Case A 68-year-old woman was diagnosed with primary lung cancer stage IIB in another hospital where she had undergone induction chemoradiotherapy and then a right pneumonectomy for non-small cell cancer (adenocarcinoma)第2頁，共12頁，2022年，5月20日，18點41分，星期二第3頁，共12頁，2022

2、年，5月20日，18點41分，星期二 Twenty-one months later, the cancer metastasized to the brain, which was treated by 2-knife radiosurgery. She had been well for up to 32 months; however, the chest radiography and chest computed tomography (CT) demonstrated a nodule in the left upper lobe of the lung that was grad

3、ually growing. Although conservative treatment was recommended by the other hospital, she hoped to undergo surgery, so she was referred to Jikei University Hospital. Chest CT showed an irregular coin lesion of 13 13mm in size in the superior segment. 第4頁，共12頁，2022年，5月20日，18點41分，星期二第5頁，共12頁，2022年，5月2

4、0日，18點41分，星期二 The lesion was diagnosed as metastatic lung cancer. The clinical test results for arterial blood gas analysis were PaO2, 95.6 torr; and PaCO2, 41.6 torr under ambient conditions and test results for spirometry were FVC, 1240 ml; %VC, 53.0 %; FEV1.0, 980 ml. Since the general condition

5、of the patient was good, we attempted the surgery, expecting to maintain the residual FEV1.0 at 900 ml after surgery. 第6頁，共12頁，2022年，5月20日，18點41分，星期二 The VATS partial resection was performed using PCPS under one-lung ventilation with 3 ports in the right lateral position. A total of 8000 U of hepari

6、n was injected intravenously through a 17-Fr arterial cannula via the right femoral artery into the abdominal aorta and through a 21-Fr venous cannula via the right femoral vein into the right atrium, with a percutaneous cardiopulmonary support (PCPS) flow of 3.3 L/min. PCPS time was 75 min and the

7、intraoperative hemodynamic status was stable. The total bleeding volume was 85 ml, and she had no complications such as embolism, thrombosis, bleeding, or infection. 第7頁，共12頁，2022年，5月20日，18點41分，星期二 The chest tube was removed on postoperative day 1 and the postoperative course was uneventful. The cli

8、nical test results of spirometry on postoperative day 5 were FVC, 1120 ml; %VC,47.9 % and FEV1.0, 1080 ml. The patient was discharged and remains well to date. Histopathological examination of the resected specimen showed metastatic carcinoma, and the surgical margin was negative for tumor.第8頁，共12頁，

9、2022年，5月20日，18點41分，星期二Discussion During partial resection, oxygenation was maintained mostly at 100% with PCPS flow of 3.3 L/min and jet ventilation. Despite preoperative heparinization with 8000U, bleeding was only 85 ml. Postoperative spirography showed no difference compared to preoperatively and

10、 no complications were encountered. The patient was discharged safely. 第9頁，共12頁，2022年，5月20日，18點41分，星期二 Two methods are available for PCPS: venoarterial (V-A) bypass and venovenous (V-V) bypass: V-A bypass offers decreased preload volume to the heart; however, it has the disadvantage of providing an

11、unequal supply of oxygen to the whole body; In contrast, V-V bypass provides an equal supply of oxygen to the whole body. We selected V-A bypass because we predicted that decreased right pulmonary arterial circulation would result in increased pulmonary vascular resistance, followed by a left lung c

12、ollapse. 第10頁，共12頁，2022年，5月20日，18點41分，星期二 Some controversial questions remain. First, we wondered whether PCPS really has any effect on the heart beat, as in this case. Intraoperatively, oxygen saturation dropped to 7080% many times, so there is a possibility that the normal heart beat may have been

13、 acting in opposition to the PCPS circulation, which would mean that the oxygen saturation could not always be maintained. Second, with regard to brain circulation, although we used a V-A bypass, we could not be sure whether oxygenated blood really circulated into the brain, because oxygenated PCPS circulation to