局部麻醉下电视胸腔镜肺切除术的探讨

Video-assisted thoracoscopic pulmonary resection under local anesthesia

目的 研究局麻下电视胸腔镜肺切除术的可行性。 方法 自 2 0 0 0年 2月至 12月 ,对 8例患者 (周围型肺小结节病变 6例 ,间质性肺病 2例 )在局麻下实施电视胸腔镜手术。 结果 1例因胸腔内致密粘连转行全麻开胸手术 ,其余均在局麻下完成肿物切除。术中病理诊断为结核 3例 ,转移癌及炎性假瘤各 1例 ,肺间质纤维化 2例。手术时间 40～ 2 0 0min。无术后并发症和死亡。手术花费平均 5 40 0元。 结论 局麻下经胸腔镜进行肺部分切除术可行。该方法对麻醉要求低、经济、微创。

Objective To study the feasibility of video-assisted thoracoscopic (VAT) minor pulmonary resection under local anesthesia. Methods From February to December 2000,8 patients (6 cases of peripheral pulmonary nodules,2 cases of respiratory insufficiency and radiographic pulmonary infiltrate)were operated on through video-assisted thoracoscopy under local anesthesia. Results Except 1 case was converted to general anesthesia and performed minithoracotomy to resect pulmonary coin lesion due to pleural adhesion,other 7 patients underwent VAT-pulmonary wedge ressction under local anesthesia and definitive diagonosis.(3 with tuberculosis,1 with metastatic adenocarcinoma,1 with inflammatory pseudotumor and 2 with pulmonary fibrosis)were obtained.The duration of the procedures was from 40 to 200 min. Spontaneous breathing and hemodynamics were maintained well during the operation.There was neither severe postoperative complications nor mortality.The postoperative hospitalized days were 2～5 days with a mean of 3 days. The average medical fee for pulmonary wedge ressction using our procedure was 5400 RMB. Conclusions VAT-minor pulmonary resection can be performed safely under local anesthesia.