無管與氣管插管單孔胸腔鏡手術臨床療效對比研究

Comparative study of the efficacy of single-port video-assisted thoracoscopic surgerywith tubeless and intubated anesthesia

目的分析無管(不需氣管插管麻醉,術中不留置尿管,術後不放置胸腔引流管)單孔胸腔鏡與傳統氣管插管單孔胸腔鏡在肺部手術中應用的可行性與優勢。方法回顧性分析2015年7月~2019年4月中國澳門鏡湖醫院胸外科同一主刀醫師及團隊實施的無管單孔胸腔鏡在肺部手術患者18例(觀察組)的臨床資料,全部為男性,年齡(30.4±12.3)歲。另抽取同期行傳統氣管插管單孔胸腔鏡肺部手術患者21例,作為對照組,其中男19例、女2例,年齡(23.3±6.8)歲。比較兩組病例在手術時間、術中失血量,麻醉時間,術後疼痛度,術後下床活動時間(h),留置胸腔引流管時間、術後住院時間、後進食時間(h),氣道損傷、頑固性乾咳、咽痛、惡心嘔吐併發症發生率等指標方面差異。結果兩組患者在年齡、性別等一般情況並無差異。兩組患者麻醉時間、術中失血量差異有統計學意義;觀察組優於對比組;手術時間差異無統計學意義。觀察組術後進食時間(h),術後下床活動時間(h),術後疼痛評分,術後住院時間(d)等方面較對照組均具有明顯優勢[(3.6±1.0)h vs.(6.0±0.0)h,P<0.001;(1.6±0.8)vs.(2.7±0.7),P<0.001;(1.3±0.6)d vs.(5.2±3.7)d,P<0.001]。結論無管單孔技術應用於胸腔鏡肺部手術是可行及安全,可避免傳統氣管插管所致氣道損傷,減少聲音嘶啞、咽痛、惡心嘔吐等全身麻醉所致症狀,減少甚至避免單肺機械通氣所造成肺損傷,減少了尿道口不適感及胸部疼痛,促進術後快速康複,縮短住院時間,更符合整體微創及快速康複的理念要求。

Objective To investigate the feasibility and superiority of tubeless VATS(no tracheal intubation anesthesia,no intraoperative catheter,no postoperative intrathoracic drain),as compared to traditional tracheal intubation of single-port thoracoscopy.Methods Retrospective analysis of 18 cases(observation group)of tubeless VATS in Kiang Wu Hospital from July 2015 to April 2019 was performed.All cases are male,with mean age 30.4±12.3.Twenty-one cases with traditional tracheal intubation of single-port thoracoscopy at the same period were used as control group,including 19 males,2females with a mean age of 23.3±6.Parameters used for comparison include the mean operating time(h),peri-operative bleeding volume(ml),anesthesia time(h),postoperative pain,postoperative activity time(h),time of indwelling chest drainage tube(h),hospital stay time(d),postoperative fasting time(h),and incidence rate of operative complications such as airway damage,intractable dry cough,pharyngalgia,nausea and vomiting.Results The two groups of patients have no significant difference in background features(e.g.sex and age).Statistical significance was shown in anesthesia time and peri-operative bleeding with the observation group performing better than the control group;there was no statistically significant difference in mean operating time.Significant advantages in terms of postoperative fasting time(h),postoperative activity time(h),postoperative pain score and hospital stay time(d)were found in observation group comparing with control group.[(3.6±1.0)h vs.(6.0±0.0)h,P<0.001;(1.6±0.8)vs.(2.7±0.7),P<0.001;(1.3±0.6)d vs.(5.2±3.7)d,P<0.001].Conclusion Tubeless VATS are feasible and safe for thoracoscopic pulmonary surgery,it can avoid airway damage caused by conventional intubation anesthesia,reduce symptoms(etc.hoarseness,pharyngalgia,nausea and vomiting)caused by general anesthesia,lessen incidence rate of lung injury caused by one-lung mechanical ventilation,reduce discomfort related to urethral catheterization,promote postoperative rapid recovery and shorten hospital stay time,all of which meet the general requirements of more rapid recovery for minimally invasive procedures.