Cerfolio Robert James, Bryant Ayesha S, Sheils Todd M, Bass Cynthia S, Bartolucci Alfred A
Section of Thoracic Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, 35294, USA.
Chest. 2004 Jul;126(1):281-5. doi: 10.1378/chest.126.1.281.
Most general thoracic surgeons use double-lumen endotracheal tube (DLET) anesthesia for all video-assisted thoracoscopic surgery (VATS). We evaluated a single-lumen endotracheal tube (SLET) for VATS for drainage of pleural effusions and pleural biopsies.
A consecutive series of patients with recurrent pleural effusions underwent VATS using an SLET and only one incision. Operations were accomplished via one 2-cm incision using a 5-mm rigid thoracoscope and mediastinoscopic biopsy forceps for directed pleural biopsies. A working area was accomplished with low tidal volumes.
There were 376 patients (191 women). The indications for VATS were a nondiagnosed or benign pleural effusion in 294 patients, and a malignant effusion in 82 patients. Two hundred eight patients underwent biopsy of the parietal pleura, and mean operative time was 17 min. Adequate visibility was obtained in all. When compared to preoperative cytology, VATS was more sensitive (45% compared to 99%, p < 0.001), had a higher negative predictive value (56% compared to 99%, p < 0.001), and was more accurate (67% compared to 99%, p < 0.001). Forty-seven percent of patients with a history of cancer had false-negative preoperative cytology results. Complications occurred in seven patients (2%), and there were three operative deaths (none related to the operative procedure).
VATS using SLET and only one incision is possible, and it affords excellent visualization of the pleural space, allowing pleural biopsies and talc insufflation. It avoids the risk, time, and cost of a DLET. It is significantly more sensitive and accurate than preoperative cytology, and it should be considered as the diagnostic and therapeutic procedure of choice in patients with recurrent pleural effusions.
大多数普通胸外科医生在所有电视辅助胸腔镜手术（VATS）中都使用双腔气管插管（DLET）麻醉。我们评估了单腔气管插管（SLET）用于VATS治疗胸腔积液引流和胸膜活检的效果。
连续一系列复发性胸腔积液患者接受了使用SLET且仅做一个切口的VATS手术。手术通过一个2厘米的切口，使用5毫米硬式胸腔镜和纵隔镜活检钳进行定向胸膜活检来完成。通过低潮气量形成一个操作区域。
共有376例患者（191例女性）。VATS的适应证为294例未确诊或良性胸腔积液患者以及82例恶性胸腔积液患者。208例患者接受了壁层胸膜活检，平均手术时间为17分钟。所有患者均获得了足够的视野。与术前细胞学检查相比，VATS更敏感（45% 对99%，p < 0.001），具有更高的阴性预测值（56% 对99%，p < 0.001），且更准确（67% 对99%，p < 0.001）。有癌症病史的患者中47%术前细胞学检查结果为假阴性。7例患者（2%）发生并发症，有3例手术死亡（均与手术操作无关）。
使用SLET且仅做一个切口的VATS是可行的，它能提供良好的胸膜腔视野，允许进行胸膜活检和滑石粉吹入。它避免了DLET的风险、时间和成本。它比术前细胞学检查显著更敏感和准确，应被视为复发性胸腔积液患者的诊断和治疗首选方法。
