非全麻下电视辅助胸腔镜手术治疗复发性气胸的探讨

VIDEO-ASSISTED THORACOSCOPIC SURGERY UNDER LOCAL AND EPIDURAL ANESTHESIA FOR RECURRENT PNEUMOTHORAX

目的 :探索微创、价廉的治疗复发性气胸 (RPT)的手术方法。方法 :在探索出可诊治胸腔积液的局麻电视辅助胸腔镜手术 (VATS)技术后 ,自 2 0 0 0年 2月～ 11月 ,对 10例RPT患者在非全麻下进行了VATS治疗。结果 :除 1例改行气管插管全麻外 ,其余均在强化加局麻下 (6例 )或 /和硬脊膜外麻醉下 (3例 )完成。见肺大疱者 6例 ,缝扎 (4例 )或切除 (2例 )肺大疱后 ,予以摩擦胸膜固定术 ;未见大疱者 3例 ,予以摩擦加滑石粉胸膜固定术。手术时间 80～ 12 0min。 4例病人诉中度疼痛。但血液动力学和血氧饱和度均无明显变化。术后无严重并发症和死亡。随访 3～ 12个月无复发。结论 :非全麻下行VATS治疗RPT是安全有效的 ,并可使治疗费用大幅度降低。

Objective:To date most video-assisted thoracoscopic operations (VATS) were performed under general anesthesia with single-lung ventilation.Howerver,for patients with limited economic condition or with other underlying severe diseases,the cost and the risk of general anesthesia itself should considered. Methods:From Feb.2000 to Nov.2000,out of 10 patients with recurrent pneumothorax,9 were treated succcessfully by video-assisted thoracic operations under local (n=6) or /and epidural (n=3) anesthesia without intubation,1 was turn to general anesthesia with intubation because the lower lobe of the patient could not expand.The procedures,suturng (n=4) or stapling (n=2) of blebs and pleural abrasion pleurodesis,were applied for the patients with blebs identified thoracoscopically.For the patients without bleb identified thoracoscopically,both pleural abrasion and talc poudrage pleurodesis (n=3) were applied.Results:The mean duration of the procedure was 108 minutes.4 patients exprerienced moderate pain.But,in all of the patients,spontaneous breathing and hemodynamics were well maintained during the operation.No significant postoperative complication was encountered.No pneumothorax had recurred at a mean follow-up of 6 months.Conclusions:VATS for the treatment of recurrent pneumothorax can be performed safely under local and epidural anesthesia.Our novel approach offers benefits of lower cost and minimal invasions to pneumothorax patients.