Pompeo Eugenio, Tacconi Federico, Mineo Davide, Mineo Tommaso Claudio
Thoracic Surgery Division, Tor Vergata University School of Medicine, Rome, Italy.
J Thorac Cardiovasc Surg. 2007 Mar;133(3):786-90. doi: 10.1016/j.jtcvs.2006.11.001.
We assessed in a randomized study the feasibility and efficacy of awake video-assisted thoracoscopic bullectomy with pleural abrasion to treat spontaneous pneumothorax.
Between January 2001 and June 2005, a total of 43 patients with primary spontaneous pneumothorax were randomly assigned by computer to undergo video-assisted thoracoscopic bullectomy and pleural abrasion under sole thoracic epidural anesthesia or general anesthesia with single-lung ventilation (control group). Primary outcome measures included technical feasibility and patient satisfaction with anesthesia as scored into 4 grades (from 1, unsatisfactory, to 4, excellent). Secondary outcome measures included global operating room time, assessment of thoracic pain by visual analog pain scale, number of nursing care calls, hospital stay, and recurrences within 12 months.
In the awake group, technical feasibility was scored as excellent, good, and satisfactory in 8, 7, and 6 patients, respectively. Intergroup comparisons (awake versus control) showed that global operating room time (78.0 +/- 20.0 vs 105.0 +/- 15.0 minutes, P < .0001), perioperative visual analog pain scale score (2.0 +/- 3.0 vs 3.5 +/- 2.0, P = .005), nursing care calls (2.0 +/- 1 vs 3.0 +/- 3.0, P = .017), hospital stay (2.0 +/- 1.0 days vs 3.0 +/- 1.0 days, P < .0001), and overall costs (2540 euros +/- 352 euros vs 3550 euros +/- 435 euros, P < .0001) were significantly better in the awake group. In the awake group, 5 patients (23.8%) could be discharged within the first 24 postoperative hours. One patient in the awake group and 2 patients in the control group had recurrences within 12 months (difference not significant).
In our study, awake video-assisted thoracoscopic bullectomy with pleural abrasion proved easily feasible and resulted in shorter hospital stays and reduced procedure-related costs while providing equivalent outcome to procedures performed under general anesthesia.
我们在一项随机研究中评估了清醒状态下电视辅助胸腔镜肺大疱切除术联合胸膜摩擦术治疗自发性气胸的可行性和疗效。
在2001年1月至2005年6月期间，共有43例原发性自发性气胸患者通过计算机随机分配，分别接受单纯胸段硬膜外麻醉下的电视辅助胸腔镜肺大疱切除术及胸膜摩擦术，或接受单肺通气的全身麻醉（对照组）。主要观察指标包括技术可行性以及患者对麻醉的满意度，满意度分为4个等级（从1分，不满意，到4分，优秀）。次要观察指标包括总手术室时间、采用视觉模拟疼痛量表评估胸痛情况、护理呼叫次数、住院时间以及12个月内的复发情况。
在清醒组中，技术可行性被评为优秀、良好和满意的患者分别有8例、7例和6例。组间比较（清醒组与对照组）显示，清醒组的总手术室时间（78.0±20.0分钟对105.0±15.0分钟，P<.0001）、围手术期视觉模拟疼痛量表评分（2.0±3.0对3.5±2.0，P=.005）、护理呼叫次数（2.0±1对3.0±3.0，P=.017）、住院时间（2.0±1.0天对3.0±1.0天,P<.0001）以及总费用（2540欧元±352欧元对3550欧元±435欧元，P<.0001）均显著优于对照组。在清醒组中，5例患者（23.8%）可在术后24小时内出院。清醒组有1例患者和对照组有2例患者在12个月内复发（差异无统计学意义）。
在我们的研究中，清醒状态下电视辅助胸腔镜肺大疱切除术联合胸膜摩擦术被证明易于实施，可缩短住院时间并降低手术相关费用，同时与全身麻醉下的手术效果相当。
