Application of pure carbon dioxide combined with modified inflation-deflation method in identifying the intersegmental plane in segmentectomy: A randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

BAI Haotian ¹ , REN Kaixiang ¹ , HUANG Jiaqi ¹ , YANG Fan ¹ , XIAO Xiao ¹ , FAN Kun ¹ , LI Yixing ¹ , ZHAO Heng ¹ , SUN Ye ² , FENG Jinteng ¹ , LI Shuo ¹ ,  GAO Shan ¹ ,  ZHANG Guangjian ¹

1. Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, P.R. China;
2. Department of Anesthesia and Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, P.R. China;

Corresponding author：

GAO Shan, Email: gao.shan@xjtu.edu.cn; ZHANG Guangjian, Email: michael8039@xjtu.edu.cn

Keywords：

Inflation-deflation; carbon dioxide; intersegment plane identification; lung segmentectomy; thoracoscope

DOI：

10.7507/1007-4848.202503079

Video：

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Objective To evaluate the effectiveness and safety of pure carbon dioxide (CO₂) combined with a modified inflation-deflation technique for identifying the intersegmental plane during thoracoscopic segmentectomy. Methods A prospective study was conducted, enrolling 30 patients diagnosed with pulmonary nodules who underwent thoracoscopic anatomical segmentectomy at the Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, from March 2024 to March 2025. Patients were randomly assigned to one of two groups using a random number table: A pure oxygen group (O₂ group, n=15, 8 females, 7 males, age 28-75 years) and a pure carbon dioxide group (CO₂ group, n=15, 8 females, 7 males, age 37-69 years). All patients underwent preoperative three-dimensional computed tomography bronchovascular angiography to reconstruct pulmonary vessels, bronchi, and the virtual intersegmental plane. The time to identification of the ideal intersegmental plane was recorded intraoperatively, along with arterial blood gas measurements before lung inflation and at 5 and 15 minutes after lung inflation on the surgical side. Results The time to identify the intersegmental plane was significantly shorter in the CO₂ group compared to the O₂ group [(151.1±39.5) s vs. (998.7±78.9) s, P<0.001], and there were no significant fluctuations in intraoperative oxygen saturation in patients in the CO₂ group. Furthermore, there were no statistically significant differences between the two groups in terms of operation duration, intraoperative blood loss, postoperative extubation time, total postoperative chest tube drainage, postoperative length of hospital stay, or postoperative complication rate (all P>0.05). Conclusion Pure CO₂ combined with a modified inflation-deflation technique can rapidly, accurately, and clearly identify the intersegmental plane, and its safety is non-inferior to that of the pure O₂ method, making it worthy of clinical promotion and application.

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med, 2020, 382(6): 503-513.
3.	Lung Cancer Incidence and Mortality with Extended Follow-up in the National Lung Screening Trial. J Thorac Oncol, 2019, 14(10): 1732-1742.
4.	Zhang Y, Fu F, Chen H. Management of ground-glass opacities in the lung cancer spectrum. Ann Thorac Surg, 2020, 110(6): 1796-1804.
5.	Aokage K, Suzuki K, Saji H, et al. Segmentectomy for ground-glass-dominant lung cancer with a tumour diameter of 3 cm or less including ground-glass opacity (JCOG1211): A multicentre, single-arm, confirmatory, phase 3 trial. Lancet Respir Med, 2023, 11(6): 540-549.
6.	Liu C, Yang Z, Li Y, et al. Intentional wedge resection versus segmentectomy for ≤2 cm ground-glass-opacity-dominant non-small cell lung cancer: A real-world study using inverse probability of treatment weighting. Int J Surg, 2024, 110(7): 4231-4239.
7.	Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
8.	Remon J, Soria JC, Peters S. Early and locally advanced non-small-cell lung cancer: An update of the ESMO Clinical Practice Guidelines focusing on diagnosis, staging, systemic and local therapy. Ann Oncol, 2021, 32(12): 1637-1642.
9.	Altorki N, Wang X, Damman B, et al. Lobectomy, segmentectomy, or wedge resection for peripheral clinical T1aN0 non-small cell lung cancer: A post hoc analysis of CALGB 140503 (Alliance). J Thorac Cardiovasc Surg, 2024, 167(1): 338-347. e1.
10.	Nex G, Schiavone M, De Palma A, et al. How to identify intersegmental planes in performing sublobar anatomical resections. J Thorac Dis, 2020, 12(6): 3369-3375.
11.	Andolfi M, Potenza R, Seguin-Givelet A, et al. Identification of the intersegmental plane during thoracoscopic segmentectomy: state of the art. Interact Cardiovasc Thorac Surg, 2020, 30(3): 329-336.
12.	Xing M, Tong L, Duan H, et al. Partial pressure of oxygen control versus modified inflation-deflation method in identifying intersegmental plane during anatomical sublobectomy: A prospective, randomized, controlled trial. J Thorac Dis, 2025, 17(2): 1042-1053.
13.	Wang J, Xu X, Wen W, et al. Modified method for distinguishing the intersegmental border for lung segmentectomy. Thorac Cancer, 2018, 9(2): 330-333.
14.	Cai L, Wang C, Luo T, et al. Delineation of intersegmental plane: Application of blood flow blocking method in pulmonary segmentectomy. J Cardiothorac Surg, 2024, 19(1): 684.
15.	Onodera K, Suzuki J, Miyoshi T, et al. Comparison of various lung intersegmental plane identification methods. Gen Thorac Cardiovasc Surg, 2023, 71(2): 90-97.
16.	Zhang X, Li C, Jin R, et al. Intraoperative identification of the intersegmental plane: From the beginning to the future. Front Surg, 2022, 9: 948878.
17.	Kah Meng L, Ghista DN, Rudolph H. Determination of pulmonary gases (O₂ & CO₂) metabolic-rates and lung diffusion coefficients based on the inspired and expired air compositions and venous blood and gas concentration. Conf Proc IEEE Eng Med Biol Soc, 2005, 2005: 6161-6164.
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19.	Wagner PD. Blood gas transport: Implications for O₂ and CO₂ exchange in lungs and tissues. Semin Respir Crit Care Med, 2023, 44(5): 584-593.
20.	Yang W, Liu Z, Yang C, et al. Combination of nitrous oxide and the modified inflation-deflation method for identifying the intersegmental plane in segmentectomy: A randomized controlled trial. Thorac Cancer, 2021, 12(9): 1398-1406.
21.	Adams SJ, Stone E, Baldwin DR, et al. Lung cancer screening. Lancet, 2023, 401(10374): 390-408.
22.	Mazzone PJ, Silvestri GA, Souter LH, et al. Screening for lung cancer: CHEST guideline and expert panel report. Chest, 2021, 160(5): e427-e494.
23.	Cheng M, Ding R, Wang S. Diagnosis and treatment of high-risk bilateral lung ground-glass opacity nodules. Asian J Surg, 2024, 47(7): 2969-2974.
24.	Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-622.
25.	Cahan WG. Radical lobectomy. J Thorac Cardiovasc Surg, 1960, 39: 555-572.
26.	Altorki N, Wang X, Kozono D, et al. Lobar or sublobar resection for peripheral stage ia non-small-cell lung cancer. N Engl J Med, 2023, 388(6): 489-498.
27.	Lin H, Peng Z, Zhou K, et al. Differential efficacy of segmentectomy and wedge resection in sublobar resection compared to lobectomy for solid-dominant stage IA lung cancer: A systematic review and meta-analysis. Int J Surg, 2024, 110(2): 1159-1171.
28.	Tsutani Y, Handa Y, Shimada Y, et al. Comparison of cancer control between segmentectomy and wedge resection in patients with clinical stage ⅠA non-small cell lung cancer. J Thorac Cardiovasc Surg, 2021, 162(4): 1244-1252. e1.
29.	Cao J, Yuan P, Wang Y, et al. Survival rates after lobectomy, segmentectomy, and wedge resection for non-small cell lung cancer. Ann Thorac Surg, 2018, 105(5): 1483-1491.
30.	Akamine T, Yotsukura M, Yoshida Y, et al. Feasibility and effectiveness of segmentectomy versus wedge resection for clinical stage Ⅰ non-small-cell lung cancer. Eur J Cardiothorac Surg, 2023, 63(3).
31.	Nakazawa S, Shimizu K, Mogi A, et al. VATS segmentectomy: Past, present, and future. Gen Thorac Cardiovasc Surg, 2018, 66(2): 81-90.
32.	Matsuura Y. Precise identification of the intersegmental plane for lung cancer segmentectomy. Transl Cancer Res, 2023, 12(2): 213-216.
33.	Zuo Y, Li L, Liu S. Kohn’s pores are not responsible for collateral ventilation between inflated and deflated segments: A microscopic study of pulmonary intersegmental septa in the human lung. J Anat, 2015, 226(4): 381-385.
34.	Misaki N, Chang SS, Gotoh M, et al. A novel method for determining adjacent lung segments with infrared thoracoscopy. J Thorac Cardiovasc Surg, 2009, 138(3): 613-618.
35.	Sugimoto S, Oto T, Miyoshi K, et al. A novel technique for identification of the lung intersegmental plane using dye injection into the segmental pulmonary artery. J Thorac Cardiovasc Surg, 2011, 141(5): 1325-1327.
36.	Chen D, Lin Y, Xu H, et al. The application of indocyanine green fluorescence imaging to determine intersegmental plane during thoracoscopic segmentectomy: A meta-analysis and systematic review. Asian J Surg, 2024.
37.	Okada M, Mimura T, Ikegaki J, et al. A novel video-assisted anatomic segmentectomy technique: selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. J Thorac Cardiovasc Surg, 2007, 133(3): 753-758.
38.	Li NL, Lin CS, Shih CH, et al. Intraoperative cardiac arrest caused by air embolism during video-assisted thoracoscopic segmentectomy. J Thorac Cardiovasc Surg, 2018, 155(3): e111-e113.
39.	Kamiyoshihara M, Kakegawa S, Morishita Y. Convenient and improved method to distinguish the intersegmental plane in pulmonary segmentectomy using a butterfly needle. Ann Thorac Surg, 2007, 83(5): 1913-1914.
40.	Oh S, Suzuki K, Miyasaka Y, et al. New technique for lung segmentectomy using indocyanine green injection. Ann Thorac Surg, 2013, 95(6): 2188-2190.
41.	Ito A, Takao M, Shimamoto A, et al. Prolonged intravenous indocyanine green visualization by temporary pulmonary vein clamping: Real-time intraoperative fluorescence image guide for thoracoscopic anatomical segmentectomy. Eur J Cardiothorac Surg, 2017, 52(6): 1225-1226.
42.	刘宝东. 胸腔镜肺段切除术段间界识别技术及生理机制研究进展. 中国胸心血管外科临床杂志, 2024, 31(9): 1351-1355.
43.	Shields TW. General thoracic surgery. Lippincott Williams & Wilkins, 2005.
44.	Tsubota N. An improved method for distinguishing the intersegmental plane of the lung. Surg Today, 2000, 30(10): 963-964.
45.	Iwata H, Shirahashi K, Mizuno Y, et al. Surgical technique of lung segmental resection with two intersegmental planes. Interact Cardiovasc Thorac Surg, 2013, 16(4): 423-425.
46.	Sun Y, Zhang Q, Wang Z, et al. Is the near-infrared fluorescence imaging with intravenous indocyanine green method for identifying the intersegmental plane concordant with the modified inflation-deflation method in lung segmentectomy? Thorac Cancer, 2019, 10(10): 2013-2021.
47.	Pfitzner J, Peacock MJ, Harris RJ. Speed of collapse of the non-ventilated lung during single-lung ventilation for thoracoscopic surgery: The effect of transient increases in pleural pressure on the venting of gas from the non-ventilated lung. Anaesthesia, 2001, 56(10): 940-946.
48.	Ko R, McRae K, Darling G, et al. The use of air in the inspired gas mixture during two-lung ventilation delays lung collapse during one-lung ventilation. Anesth Analg, 2009, 108(4): 1092-1096.
49.	Myles PS, Leslie K, Chan MT, et al. Avoidance of nitrous oxide for patients undergoing major surgery: A randomized controlled trial. Anesthesiology, 2007, 107(2): 221-231.
50.	Ghista D, Loh K, Ng D. Lung gas composition and transfer analysis: O2 and CO2 diffusion coefficients and metabolic rates. Human Respiration, 2006: 77-93.
51.	Chakraborty S, Balakotaiah V, Bidani A. Diffusing capacity reexamined: relative roles of diffusion and chemical reaction in red cell uptake of O₂, CO, CO₂, and NO. J Appl Physiol (1985), 2004, 97(6): 2284-2302.
52.	Mairbäurl H, Weber RE. Oxygen transport by hemoglobin. Compr Physiol, 2012, 2(2): 1463-1489.
53.	Shigemura M, Lecuona E, Sznajder JI. Effects of hypercapnia on the lung. J Physiol, 2017, 595(8): 2431-2437.
54.	Weinberger SE, Schwartzstein RM, Weiss JW. Hypercapnia. N Engl J Med, 1989, 321(18): 1223-1231.
55.	Bautista AF, Akca O. Hypercapnia: Is it protective in lung injury? Med Gas Res, 2013, 3(1): 23.
56.	Brower RG, Matthay MA, Morris A, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med, 2000, 342(18): 1301-1308.
57.	Laffey JG, O’Croinin D, McLoughlin P, et al. Permissive hypercapnia–role in protective lung ventilatory strategies. Intensive Care Med, 2004, 30(3): 347-356.
58.	Shibata K, Cregg N, Engelberts D, et al. Hypercapnic acidosis may attenuate acute lung injury by inhibition of endogenous xanthine oxidase. Am J Respir Crit Care Med, 1998, 158(5 Pt 1): 1578-1584.
59.	Kregenow DA, Rubenfeld GD, Hudson LD, et al. Hypercapnic acidosis and mortality in acute lung injury. Crit Care Med, 2006, 34(1): 1-7.
60.	Hickling KG, Walsh J, Henderson S, et al. Low mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercapnia: A prospective study. Crit Care Med, 1994, 22(10): 1568-1578.
61.	Contreras M, Masterson C, Laffey JG. Permissive hypercapnia: What to remember. Curr Opin Anaesthesiol, 2015, 28(1): 26-37.
62.	Sinclair SE, Kregenow DA, Starr I, et al. Therapeutic hypercapnia and ventilation-perfusion matching in acute lung injury: Low minute ventilation vs inspired CO2. Chest, 2006, 130(1): 85-92.
63.	Gao W, Liu DD, Li D, et al. Effect of therapeutic hypercapnia on inflammatory responses to one-lung ventilation in lobectomy patients. Anesthesiology, 2015, 122(6): 1235-1252.
64.	O’Croinin BR, Young DA, Maier LE, et al. Influence of hypercapnia and hypercapnic hypoxia on the heart rate response to apnea. Physiol Rep, 2024, 12(11): e16054.
65.	Almanza-Hurtado A, Polanco Guerra C, Martínez-Ávila MC, et al. Hypercapnia from physiology to practice. Int J Clin Pract, 2022, 2022: 2635616.
66.	Strapazzon G, Gatterer H, Falla M, et al. Hypoxia and hypercapnia effects on cerebral oxygen saturation in avalanche burial: A pilot human experimental study. Resuscitation, 2021, 158: 175-182.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med, 2020, 382(6): 503-513.
3. Lung Cancer Incidence and Mortality with Extended Follow-up in the National Lung Screening Trial. J Thorac Oncol, 2019, 14(10): 1732-1742.
4. Zhang Y, Fu F, Chen H. Management of ground-glass opacities in the lung cancer spectrum. Ann Thorac Surg, 2020, 110(6): 1796-1804.
5. Aokage K, Suzuki K, Saji H, et al. Segmentectomy for ground-glass-dominant lung cancer with a tumour diameter of 3 cm or less including ground-glass opacity (JCOG1211): A multicentre, single-arm, confirmatory, phase 3 trial. Lancet Respir Med, 2023, 11(6): 540-549.
6. Liu C, Yang Z, Li Y, et al. Intentional wedge resection versus segmentectomy for ≤2 cm ground-glass-opacity-dominant non-small cell lung cancer: A real-world study using inverse probability of treatment weighting. Int J Surg, 2024, 110(7): 4231-4239.
7. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
8. Remon J, Soria JC, Peters S. Early and locally advanced non-small-cell lung cancer: An update of the ESMO Clinical Practice Guidelines focusing on diagnosis, staging, systemic and local therapy. Ann Oncol, 2021, 32(12): 1637-1642.
9. Altorki N, Wang X, Damman B, et al. Lobectomy, segmentectomy, or wedge resection for peripheral clinical T1aN0 non-small cell lung cancer: A post hoc analysis of CALGB 140503 (Alliance). J Thorac Cardiovasc Surg, 2024, 167(1): 338-347. e1.
10. Nex G, Schiavone M, De Palma A, et al. How to identify intersegmental planes in performing sublobar anatomical resections. J Thorac Dis, 2020, 12(6): 3369-3375.
11. Andolfi M, Potenza R, Seguin-Givelet A, et al. Identification of the intersegmental plane during thoracoscopic segmentectomy: state of the art. Interact Cardiovasc Thorac Surg, 2020, 30(3): 329-336.
12. Xing M, Tong L, Duan H, et al. Partial pressure of oxygen control versus modified inflation-deflation method in identifying intersegmental plane during anatomical sublobectomy: A prospective, randomized, controlled trial. J Thorac Dis, 2025, 17(2): 1042-1053.
13. Wang J, Xu X, Wen W, et al. Modified method for distinguishing the intersegmental border for lung segmentectomy. Thorac Cancer, 2018, 9(2): 330-333.
14. Cai L, Wang C, Luo T, et al. Delineation of intersegmental plane: Application of blood flow blocking method in pulmonary segmentectomy. J Cardiothorac Surg, 2024, 19(1): 684.
15. Onodera K, Suzuki J, Miyoshi T, et al. Comparison of various lung intersegmental plane identification methods. Gen Thorac Cardiovasc Surg, 2023, 71(2): 90-97.
16. Zhang X, Li C, Jin R, et al. Intraoperative identification of the intersegmental plane: From the beginning to the future. Front Surg, 2022, 9: 948878.
17. Kah Meng L, Ghista DN, Rudolph H. Determination of pulmonary gases (O₂ & CO₂) metabolic-rates and lung diffusion coefficients based on the inspired and expired air compositions and venous blood and gas concentration. Conf Proc IEEE Eng Med Biol Soc, 2005, 2005: 6161-6164.
18. Visser BF. Pulmonary diffusion of carbon dioxide. Phys Med Biol, 1960, 5: 155-166.
19. Wagner PD. Blood gas transport: Implications for O₂ and CO₂ exchange in lungs and tissues. Semin Respir Crit Care Med, 2023, 44(5): 584-593.
20. Yang W, Liu Z, Yang C, et al. Combination of nitrous oxide and the modified inflation-deflation method for identifying the intersegmental plane in segmentectomy: A randomized controlled trial. Thorac Cancer, 2021, 12(9): 1398-1406.
21. Adams SJ, Stone E, Baldwin DR, et al. Lung cancer screening. Lancet, 2023, 401(10374): 390-408.
22. Mazzone PJ, Silvestri GA, Souter LH, et al. Screening for lung cancer: CHEST guideline and expert panel report. Chest, 2021, 160(5): e427-e494.
23. Cheng M, Ding R, Wang S. Diagnosis and treatment of high-risk bilateral lung ground-glass opacity nodules. Asian J Surg, 2024, 47(7): 2969-2974.
24. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-622.
25. Cahan WG. Radical lobectomy. J Thorac Cardiovasc Surg, 1960, 39: 555-572.
26. Altorki N, Wang X, Kozono D, et al. Lobar or sublobar resection for peripheral stage ia non-small-cell lung cancer. N Engl J Med, 2023, 388(6): 489-498.
27. Lin H, Peng Z, Zhou K, et al. Differential efficacy of segmentectomy and wedge resection in sublobar resection compared to lobectomy for solid-dominant stage IA lung cancer: A systematic review and meta-analysis. Int J Surg, 2024, 110(2): 1159-1171.
28. Tsutani Y, Handa Y, Shimada Y, et al. Comparison of cancer control between segmentectomy and wedge resection in patients with clinical stage ⅠA non-small cell lung cancer. J Thorac Cardiovasc Surg, 2021, 162(4): 1244-1252. e1.
29. Cao J, Yuan P, Wang Y, et al. Survival rates after lobectomy, segmentectomy, and wedge resection for non-small cell lung cancer. Ann Thorac Surg, 2018, 105(5): 1483-1491.
30. Akamine T, Yotsukura M, Yoshida Y, et al. Feasibility and effectiveness of segmentectomy versus wedge resection for clinical stage Ⅰ non-small-cell lung cancer. Eur J Cardiothorac Surg, 2023, 63(3).
31. Nakazawa S, Shimizu K, Mogi A, et al. VATS segmentectomy: Past, present, and future. Gen Thorac Cardiovasc Surg, 2018, 66(2): 81-90.
32. Matsuura Y. Precise identification of the intersegmental plane for lung cancer segmentectomy. Transl Cancer Res, 2023, 12(2): 213-216.
33. Zuo Y, Li L, Liu S. Kohn’s pores are not responsible for collateral ventilation between inflated and deflated segments: A microscopic study of pulmonary intersegmental septa in the human lung. J Anat, 2015, 226(4): 381-385.
34. Misaki N, Chang SS, Gotoh M, et al. A novel method for determining adjacent lung segments with infrared thoracoscopy. J Thorac Cardiovasc Surg, 2009, 138(3): 613-618.
35. Sugimoto S, Oto T, Miyoshi K, et al. A novel technique for identification of the lung intersegmental plane using dye injection into the segmental pulmonary artery. J Thorac Cardiovasc Surg, 2011, 141(5): 1325-1327.
36. Chen D, Lin Y, Xu H, et al. The application of indocyanine green fluorescence imaging to determine intersegmental plane during thoracoscopic segmentectomy: A meta-analysis and systematic review. Asian J Surg, 2024.
37. Okada M, Mimura T, Ikegaki J, et al. A novel video-assisted anatomic segmentectomy technique: selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. J Thorac Cardiovasc Surg, 2007, 133(3): 753-758.
38. Li NL, Lin CS, Shih CH, et al. Intraoperative cardiac arrest caused by air embolism during video-assisted thoracoscopic segmentectomy. J Thorac Cardiovasc Surg, 2018, 155(3): e111-e113.
39. Kamiyoshihara M, Kakegawa S, Morishita Y. Convenient and improved method to distinguish the intersegmental plane in pulmonary segmentectomy using a butterfly needle. Ann Thorac Surg, 2007, 83(5): 1913-1914.
40. Oh S, Suzuki K, Miyasaka Y, et al. New technique for lung segmentectomy using indocyanine green injection. Ann Thorac Surg, 2013, 95(6): 2188-2190.
41. Ito A, Takao M, Shimamoto A, et al. Prolonged intravenous indocyanine green visualization by temporary pulmonary vein clamping: Real-time intraoperative fluorescence image guide for thoracoscopic anatomical segmentectomy. Eur J Cardiothorac Surg, 2017, 52(6): 1225-1226.
42. 刘宝东. 胸腔镜肺段切除术段间界识别技术及生理机制研究进展. 中国胸心血管外科临床杂志, 2024, 31(9): 1351-1355.
43. Shields TW. General thoracic surgery. Lippincott Williams & Wilkins, 2005.
44. Tsubota N. An improved method for distinguishing the intersegmental plane of the lung. Surg Today, 2000, 30(10): 963-964.
45. Iwata H, Shirahashi K, Mizuno Y, et al. Surgical technique of lung segmental resection with two intersegmental planes. Interact Cardiovasc Thorac Surg, 2013, 16(4): 423-425.
46. Sun Y, Zhang Q, Wang Z, et al. Is the near-infrared fluorescence imaging with intravenous indocyanine green method for identifying the intersegmental plane concordant with the modified inflation-deflation method in lung segmentectomy? Thorac Cancer, 2019, 10(10): 2013-2021.
47. Pfitzner J, Peacock MJ, Harris RJ. Speed of collapse of the non-ventilated lung during single-lung ventilation for thoracoscopic surgery: The effect of transient increases in pleural pressure on the venting of gas from the non-ventilated lung. Anaesthesia, 2001, 56(10): 940-946.
48. Ko R, McRae K, Darling G, et al. The use of air in the inspired gas mixture during two-lung ventilation delays lung collapse during one-lung ventilation. Anesth Analg, 2009, 108(4): 1092-1096.
49. Myles PS, Leslie K, Chan MT, et al. Avoidance of nitrous oxide for patients undergoing major surgery: A randomized controlled trial. Anesthesiology, 2007, 107(2): 221-231.
50. Ghista D, Loh K, Ng D. Lung gas composition and transfer analysis: O2 and CO2 diffusion coefficients and metabolic rates. Human Respiration, 2006: 77-93.
51. Chakraborty S, Balakotaiah V, Bidani A. Diffusing capacity reexamined: relative roles of diffusion and chemical reaction in red cell uptake of O₂, CO, CO₂, and NO. J Appl Physiol (1985), 2004, 97(6): 2284-2302.
52. Mairbäurl H, Weber RE. Oxygen transport by hemoglobin. Compr Physiol, 2012, 2(2): 1463-1489.
53. Shigemura M, Lecuona E, Sznajder JI. Effects of hypercapnia on the lung. J Physiol, 2017, 595(8): 2431-2437.
54. Weinberger SE, Schwartzstein RM, Weiss JW. Hypercapnia. N Engl J Med, 1989, 321(18): 1223-1231.
55. Bautista AF, Akca O. Hypercapnia: Is it protective in lung injury? Med Gas Res, 2013, 3(1): 23.
56. Brower RG, Matthay MA, Morris A, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med, 2000, 342(18): 1301-1308.
57. Laffey JG, O’Croinin D, McLoughlin P, et al. Permissive hypercapnia–role in protective lung ventilatory strategies. Intensive Care Med, 2004, 30(3): 347-356.
58. Shibata K, Cregg N, Engelberts D, et al. Hypercapnic acidosis may attenuate acute lung injury by inhibition of endogenous xanthine oxidase. Am J Respir Crit Care Med, 1998, 158(5 Pt 1): 1578-1584.
59. Kregenow DA, Rubenfeld GD, Hudson LD, et al. Hypercapnic acidosis and mortality in acute lung injury. Crit Care Med, 2006, 34(1): 1-7.
60. Hickling KG, Walsh J, Henderson S, et al. Low mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercapnia: A prospective study. Crit Care Med, 1994, 22(10): 1568-1578.
61. Contreras M, Masterson C, Laffey JG. Permissive hypercapnia: What to remember. Curr Opin Anaesthesiol, 2015, 28(1): 26-37.
62. Sinclair SE, Kregenow DA, Starr I, et al. Therapeutic hypercapnia and ventilation-perfusion matching in acute lung injury: Low minute ventilation vs inspired CO2. Chest, 2006, 130(1): 85-92.
63. Gao W, Liu DD, Li D, et al. Effect of therapeutic hypercapnia on inflammatory responses to one-lung ventilation in lobectomy patients. Anesthesiology, 2015, 122(6): 1235-1252.
64. O’Croinin BR, Young DA, Maier LE, et al. Influence of hypercapnia and hypercapnic hypoxia on the heart rate response to apnea. Physiol Rep, 2024, 12(11): e16054.
65. Almanza-Hurtado A, Polanco Guerra C, Martínez-Ávila MC, et al. Hypercapnia from physiology to practice. Int J Clin Pract, 2022, 2022: 2635616.
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