肺癌患者不同手术方式围术期与麻醉相关配合136例报道

The cooperation with anesthesia in different operative ways among lung cancer perioperative period:an analysis of 136 case

目的探讨肺癌患者不同手术方式围术期与麻醉相关配合。方法回顾性分析136例早期肺癌患者的手术实践以及麻醉管理。按手术方式分为传统开胸手术组(52例)和胸腔镜手术组(84例)(传统三孔式胸腔镜肺叶切除术50例、单操作孔胸腔镜肺叶切除术26例、单孔胸腔镜肺叶切除术8例)。麻醉插管采用静脉复合全身麻醉双腔支气管导管法或支气管封堵器法,术中单肺通气,监测Sp O2,ECG,BP,Peak,PETCO2,尿量及吸入麻醉药浓度。全组手术均行肺叶切除加纵隔淋巴结清扫。结果全组患者无1例围术期死亡。术中单肺通气效果均较满意,双腔支气管插管法115例,其中4例因困难气道使用纤维支气管镜辅助定位下插管;支气管封堵器法插管21例。全组手术时间及淋巴结清扫数量相当,胸腔镜手术组与传统开胸手术组分别有5例、3例术中出现低氧血症,单操作孔胸腔镜手术有1例因术中出血而中转开胸。术后患者拔管顺利,恢复良好。结论肺癌手术中术者与麻醉师应当密切配合,不同手术方式采用不同处理方法。

Objective To explore the cooperation with anesthesia in different operative ways among lung cancer perioperative period.Methods Retrospective analysis of surgery practice and anesthesia management in 136 cases with early stage lung cancer were made. Patients were assigned to conventional thoracotomy group （52 cases） and VATS group （84 cases） （conventional 3port VATS 50 cases, single utility port VATS 26 cases, single port VATS 8 cases）. Double lumen endotracheal tube or bronchial blocker was used in vein combined anesthesia intubation. One-lung ventilation was used and SpO2, ECG, BP, Peak, PETCO2, volume of urine, and inhalation anesthetic drug concentration were monitored during anesthesia. All operations included lobectomy and mediastinal lymph node resection.Results There was no perioperative death and both basically satisfied in one lung ventilation. Double lumen endotracheal tube （115 cases）, including 4 cases localized by fiberbronchoscope assist because of difficult airway and bronchial blocker （21cases）. All groups consumed approximately equal times in operation and equal numbers in removed lymph nodes. VATS group and open thoracotomy surgery group had 5 and 3 cases of hyoxemia individually. One case turned to pulmonary lobectomy because of heavy bleeding in single utility port VATS. Patients extubated smoothly and made good recovery after operation.Conclusion Close cooperation is needed in operator and anesthetist among lung cancer surgery, in different operative ways, and different methods.