局麻下经电视胸腔镜肺肿物切除术

Video－Assisted Thoracoscopic Resection of Pulmonary Nodules under Local Anesthesia

目的：研究局麻下经电视胸腔镜切除肺部小肿物的可行性。方法：在熟练掌握常规电视胸腔镜手术技术的基础上，并在局麻下行电视胸腔镜治疗自发性气胸获成功后，自2000年2月到12月，对6例周围型肺肿物患者实施了局麻下胸腔镜手术。结果：除1例因发现胸腔内有致密粘连、而转行全麻开胸手术外，其余均在局麻下完成肿物切除。术中冰冻病理诊为结核病变3例，转移癌和炎性假瘤各1例。手术时间120～200分钟。无术后并发症和死亡。结论：局麻下经胸腔镜能够完成肺周围病变切除术。该方法经济、微创、对麻醉要求低，利于临床普遍开展。

Objective Video－assisted thoracic surgery VATS has many advantages over traditional thoracotomy for diagnosis and treatment of peripheral pulmonary nodules． Expense of the established VATS approaches has limited their application in China.even in Asia． In the following pilot study.the feasibility of thoracoscopic pulmonary nodule resection under local anesthesia would be evaluated． Methods From March the December 2000.6 patients with peripheral pulmonary nodule were operated through VATS under local anesthesia． Results Except one was converted to general anesthesia and minithoracotomy to resect his lesion due to pleural adhesion.other 5 patients had their pulmonary nodules resected through VATS under local anesthesia.and definitive diagnosis 3 with tuberculosis.1 with inflammatory pseudotumor and 1 with matastatic carcinoma made intraoperatively by frozen section． The duration of the procedures was from 120～200 minutes． Spontaneous breathing and hemodynamics were maintained well during the operation． There was ic carcinoma neither severe operative complications nor mortality． The postoperative hospital stay was 2～5 days mean＝3 days． The average medical fee for resection of pulmonary nodule using the novel procedure was 8100 RMB． Conclusion Video－assisted thoracoscopic resection of peripheral pulmonary nodule can be performed safelty under local anesthesia． The novel approach will be the most cost－effective procedure for management of pulmonary nodules in the present time．