视频辅助胸腔镜手术采用局部麻醉和镇静：384 例连续病例。

Video-assisted thoracic surgery utilizing local anesthesia and sedation: 384 consecutive cases.

机构信息

Division of Thoracic Surgery, Geisinger Health System, Wilkes-Barre, Pennsylvania, USA.

出版信息

Ann Thorac Surg. 2010 Jul;90(1):240-5. doi: 10.1016/j.athoracsur.2010.02.113.

DOI:10.1016/j.athoracsur.2010.02.113

PMID:20609784

Abstract

BACKGROUND

Video-assisted thoracic surgery (VATS) is usually performed with general anesthesia and endotracheal intubation. There are risks to such anesthesia and some operations may not require general anesthesia or intubation. We elected to study the safety and efficacy of VATS utilizing local anesthesia, sedation, and spontaneous ventilation.

METHODS

The medical records of all patients undergoing VATS utilizing local anesthesia and sedation at our system's three hospitals between June 1, 2002 and June 1, 2009 were retrospectively reviewed. The authors or residents under supervision performed all procedures. Unsuccessful attempts at this technique were eligible for inclusion but there were none. No patient was excluded based on age or comorbidity. All procedures were performed in the operating room with patients in full lateral position; no patient had endotracheal intubation or epidural or nerve block analgesia.

RESULTS

Three hundred fifty-three patients ranging in age from 21 to 100 years (mean 67 years) underwent 384 VATS operations: pleural biopsy-drainage with or without talc, 244; drainage of empyema, 74; lung biopsy, 40; evacuate hemothorax, 13; pericardial window, 7; drain lung abscess, 2; treat chylothorax, 2; treat pneumothorax, 1; and biopsy mediastinal mass, 1. No patient required intubation or conversion to thoracotomy. No patient required a subsequent biopsy for diagnosis; two patients required a subsequent procedure for empyema. There were 10 complications: cerebrovascular accident, 2; atrial fibrillation, 2; persistent air leak, 2; empyema, transient renal failure, transient respiratory failure, and urinary tract infection, 1 each. There were no deaths due to operation; within 30 days 9 patients died from underlying disease and 1 from overanticoagulation.

CONCLUSIONS

Video-assisted thoracic surgery utilizing local anesthesia-sedation is well tolerated, safe, and valuable for an increasing number of indications.

摘要

背景

电视辅助胸腔镜手术（VATS）通常在全身麻醉和气管插管下进行。这种麻醉存在风险，有些手术可能不需要全身麻醉或插管。我们选择研究利用局部麻醉、镇静和自主呼吸进行 VATS 的安全性和有效性。

方法

回顾性分析 2002 年 6 月 1 日至 2009 年 6 月 1 日期间，我们系统的三家医院中所有接受局部麻醉和镇静 VATS 的患者的病历。作者或在监督下的住院医师进行了所有手术。该技术不成功的尝试都有资格入选，但没有。没有根据年龄或合并症排除任何患者。所有手术均在手术室中进行，患者处于完全侧卧位置；没有患者进行气管插管或硬膜外或神经阻滞镇痛。

结果

年龄在 21 至 100 岁之间（平均 67 岁）的 353 名患者接受了 384 例 VATS 手术：胸膜活检引流伴或不伴滑石粉，244 例；脓胸引流，74 例；肺活检，40 例；清除血胸，13 例；心包开窗术，7 例；引流肺脓肿，2 例；治疗乳糜胸，2 例；治疗气胸，1 例；纵隔肿块活检，1 例。没有患者需要插管或转为开胸手术。没有患者需要进一步活检来明确诊断；2 例患者需要进一步治疗脓胸。有 10 例并发症：脑血管意外，2 例；心房颤动，2 例；持续性气胸，2 例；脓胸、短暂性肾功能衰竭、短暂性呼吸衰竭和尿路感染，各 1 例。没有手术相关死亡病例；术后 30 天内，9 例患者死于基础疾病，1 例患者死于过度抗凝。