| BackgroundLung isolation techniques are commonly used in thoracic surgery to ensure clear operating field,the correct position of double-lumen endobronchial tubes(DLT)is the primary condition.In some patients,due to the abnormal anatomy of the right superior bronchus orifice or the rotation of the right-sided DLT(R-DLT),proper alignment between the slot and the origin of the right upper bronchus is difficult to accomplish or even impossible.Few studies have been conducted to predict the depth of intubation and the rotation angle of the R-DLT through preoperative three-dimensional reconstruction of the airway to get an optimal position of the tube,a time-saving bronchoscopic positioning and a lower incidence of complications related to one lung ventilation.ObjectiveBased on the regression equation of the height and depth of intubation obtained from our previous study,this study was designed to evaluate the feasibility of assessing the R-DLT position by observing the anatomy of the right superior bronchus orifice through three-dimensional reconstruction of the airway.Methods130 adult patients underwent selective thoracic surgery with R-DLT were randomly divided into targeted-trail group and control group.The proper size of R-DLT was determined by measuring the tracheal width at the level of the clavicles from posteroanterior chest radiographs for both groups.The depth of R-DLT was predicted according to the regression equation of the height and depth of intubation in the control group.The distance from carina to the center of the right superior bronchus orifice within the plane(L1)and the position of right superior bronchus orifice bronchial orientation of the transverse section(degree,D)of targeted-trail group were obtained from the preoperative three-dimensional airway reconstruction.And then the patients’ depth of intubation was predicted by L1,D together with the regression equation.Intubation was guided by the measured anatomical data of the right superior bronchus orifice,which includes intubation depth and rotation angle adjustment.After intubating,the position of R-DLT was confirmed by the fiberoptic bronchoscope(FOB).If the right superior bronchus orifice was visible through the slot,the initial positioning was defined as successful.The success rate of initial positioning and the duration of FOB were recorded and compared between the two groups.ResultsThe length of right main bronchus in the targeted-trail group was(19±3)mm.The central angle in the transverse section of right main bronchus between the central point of right superior bronchus orifice to 12 o’clock position was D(103±14)°,and the rotation angle was D2(14±12)°.The success rate of initial positioning in the targeted-trail group was 92.31%(60/65),which were significantly higher than that in the control group(46.15%,30/65)(P<0.001).The duration of FOB positioning in the supine position in the targeted-trail group was(29±9)s,which was shorter than that of the control group(59±35)s(P<0.001).There were no oral and dental injuries between the two groups,and there were no significant differences in the incidence of complications related to one lung ventilation,surgical exposure,postoperative hoarseness and throat pain(P>0.05).ConclusionsPreoperative three-dimensional airway reconstruction can observe and evaluation the anatomy of the right superior bronchus orifice,predict the intubation depth and tube end rotation angle of R-DLT,improve the success rate of R-DLT preliminary alignment,reduce the duration of FOB positioning.It’s an effective method to optimize the R-DLT positioning process.Meanwhile,it can detect potential airway abnormalities in advance and guide the airway management and the use of lung isolation tools. |
