非氣管內插管自主呼吸麻醉下電視胸腔鏡手術治療縱隔腫瘤62例臨床分析

張鑫　郭志華　李京沛　黃偉哲

【摘要】 目的：探討非氣管內插管自主呼吸麻醉下電視胸腔鏡手術（VATS）治療縱隔腫瘤可行性與安全性。方法：回顧性分析2011年12月-2017年3月在本院進行VATS手術治療的縱隔腫瘤患者124例，根據不同的手術方法分為試驗組與對照組，每組各62例。試驗組采用非氣管內插管自主呼吸胸腔鏡下縱隔腫瘤切除術，對照組同期采用雙腔管氣管內插管全麻下行VATS手術治療，比較兩組患者的圍術期相關指標以及術后并發癥發生率。結果：兩組患者手術均順利，無術中或術后死亡。兩組手術患者的手術時間、術中出血量、術后住院時間比較差異無統計學意義（P>0.05）。術后早期下床活動時間、進食時間，術后咽喉疼痛、刺激性干咳等并發癥發生率顯著低于對照組（P<0.05）。結論：非氣管內插管自主呼吸麻醉下VATS治療縱隔腫瘤是可行性與安全的，有利患者術后的快速康復，減少術后并發癥，值得臨床推廣應用。

【關鍵詞】 縱隔腫瘤； 電視胸腔鏡手術； 自主呼吸麻醉

The Clinical Analysis of Video-assisted Thoracoscopic Surgery in 62 Cases of Mediastinal Tumor by Spontaneous Breathing under Intravenous Anesthesia/ZHANG Xin，GUO Zhi-hua，LI Jing-pei，et al.//Medical Innovation of China，2017，14（22）：001-005

【Abstract】 Objective：To investigate the clinical curative effect of mediastinal tumor resection under thoracoscope in the treatment of mediastinal tumor by spontaneous breathing under intravenous anesthesia.Method：The clinical data of 124 patients with mediastinum tumor in our hospital from December 2011 to March 2017 were retrospective analyzed and divided into two groups according to the different operation method，62 cases in each group.The control group was given traditional video-assisted thoracic surgery（VATS）mediastinal tumor resection under endotracheal tube anesthesia，while the experimental group was performed VATS mediastinal tumor resection by spontaneous breathing under intravenous anesthesia.The difference of operation time，intra-operative blood loss，postoperative ambulation time，postoperative feeding time， pharyngodynia，irritable cough，length of hospital stay and postoperative complications between the two groups were compared.Result：Two groups of patients were operated successfully，without intraoperative or postoperative death.The differences were no statistically significant in the operation time，intraoperative blood loss，and length of hospital stay of two groups（P<0.05）.The postoperative ambulation time and postoperative feeding time，pharyngodynia and irritable cough in experimental group were better than those of control group（P<0.05）.Conclusion：The VATS mediastinal tumor resection by spontaneous breathing under intravenous anesthesia are feasibility and safety in selected patiens.It has curative clinical effect for mediastinal tumor with patients recover quickly and fewer complications，less surgical trauma，it is more worthy of clinical application.

【Key words】 Mediastinal tumor； Video-assisted thoracoscope； Spontaneous breathing under intravenous anesthesia

First-authors address：The First Affiliated Hospital of Guangzhou Medical University，Guangzhou 510120，Chinaendprint

doi：10.3969/j.issn.1674-4985.2017.22.001

縱隔含有多種重要器官和神經組織，胚生結構來源復雜，容易發生各種類型的囊腫與腫瘤，如胸腺腫瘤、神經源性腫瘤、氣管囊腫等各種組織來源性的腫瘤[1]。標準開胸手術能夠滿足絕大部分縱隔腫瘤患者的治療，但是切口較大，創傷大，手術出血較多，對患者呼吸循環功能影響較大，很多年齡較大、肺部功能較差的患者無法承受這么大的手術創傷。近年來，微創技術在心胸外科的應用越來越成熟，電視胸腔鏡手術（VATS）切除縱隔腫瘤的安全性得到很大提升[2]。胸腔鏡下縱隔腫瘤切除術減少開胸手術的創傷及并發癥，且鏡下具有視野放大效應使切除范圍更徹底，在縱隔腫瘤的外科治療上顯示出獨特優勢。目……