복강경하 Burch 수술시 발생한 피하기종과 기종격증 - 증례 보고

Laparoscopic Burch operation is one of laparoscopic surgery for stress urinary incontinence. Subcutaneous emphysema and hypercarbia are potential complications of laparoscopic surgery, but are more likely to occur in extraperitoneal surgery than in intraperitoneal surgery, since insufflated CO2 can diffuse easily into the surrounding tissues. We report a patient in whom pneumomediastinum and extensive subcutaneous emphysema developed during laparoscopic Burch operation. Transient hypoxemia was also accompanied with hypercarbia. Possible mechanisms are presented, along with discussion of prompt diagnosis and treatment. For the management of laparoscopic extraperitoneal surgery, it is necessary to be careful with monitoring of CO2 insufflation pressure, routine examination and palpation of chest wall, use of N2O with caution, increase of ventilation to eliminate CO2, and excluding other causes of subcutaneous emphysema and hypercarbia. (Korean J Anesthesiol 1997; 32: 467∼472)