胸腔镜手术严重并发症的防治

Prevention and treatment of severe complications of thoracoscopy

目的 探讨预防和早期诊治胸腔镜手术严重并发症。 方法 胸腔镜手术 4 0 0例 ,年龄(18～ 81)岁 ,ASAⅠ -Ⅲ ,32 0例肺大泡切除手术 ,80例为胸腔、纵隔、肺肿瘤活检或切除术 ,应用双腔支气管麻醉 ,术中单肺通气 ,多功能监护仪监测循环、呼吸等功能。 结果 严重并发症 8例 ,其中严重复张性肺水肿 5例 ,大量胸水致双腔支气管完全阻塞 1例 ,大出血 1例 ,双侧气胸致循环骤停 1例。 8例均抢救成功 ,痊愈出院。 结论 胸腔镜手术必须充分做好术前准备 ,应用双腔支气管单肺麻醉 ,术中严密观察 ,及早诊治并发症 ,可提高胸腔镜手术的安全性。

Objective Study the prevention and early diagnosis of severe complications of thoracoscopy. Methods 400 patients,(18～81)years,ASA Ⅰ-Ⅲ,underwent thoracoscoy,including 320 pulmonary bubble resections and 80 thorax,mediastinum or lung tumor biopsy or resections.All patients were anesthetized with one-lung ventilation using a double-lumen tube and monitored continuously in circulatory and respiratory functions with a multi-runctional monitor. Results Severe intraoperative complications occurred in 8 patients,including 5 reexpansion pulmonary edema,1 complete occlusion of double-lumen tube due to massive pleural effusion,1 massive bleeding and 1 cardiac arrest due to bilateral pneumothorax.All complications were successfully treated and the patients were cured and discharged. Conclusions Thoracoscopy must be well prepared.Applying one lung anesthesia with double-lumen tube,careful observation during operation,early recognition and treatment of complications may contribute to assuring the safety of this procedure.