Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Ann Surg. 2011 Dec;254(6):1038-43. doi: 10.1097/SLA.0b013e31822ed19b.
To evaluate the feasibility and safety of thoracoscopic lobectomy without endotracheal intubation.
General anesthesia with single-lung ventilation is considered mandatory for thoracoscopic lobectomy for non-small cell lung cancer (NSCLC). Nonintubated thoracoscopic lobectomy has not been reported previously.
From August 2009 through June 2010, some 30 consecutive patients with clinical stage I or II NSCLC were treated by nonintubated thoracoscopic lobectomy using epidural anesthesia, intrathoracic vagal blockade, and sedation. To evaluate the feasibility and safety of this novel technique, they were compared with a control group consisting of 30 consecutive patients with clinical stage I or II NSCLC who underwent thoracoscopic lobectomy using intubated general anesthesia from August 2008 through July 2009.
Collapse of the operative lung and inhibition of coughing were satisfactory in the nonintubated patients, induced by spontaneous breathing, and vagal blockade. Three patients in the nonintubated group required conversion to intubated-single lung ventilation because of persistent hypoxemia, poor epidural anesthesia pain control, and bleeding. One patient in each group was converted to thoracotomy because of bleeding. The 2 groups had comparable anesthesia durations, surgical durations, blood loss, and numbers of dissected lymph nodes. Patients who underwent nonintubated surgery had lower rates of sore throat (6.7% vs 40.0%, P = 0.002) and earlier resumption of oral intake (mean, 4.7 hours vs 18.8 hours, P < 0.001). Patients undergoing nonintubated surgery also had a trend toward better noncomplication rates (90% vs 66.7%, P = 0.057) and shorter postoperative hospital stays (mean, 5.9 days vs 7.1 days, P = 0.078).
Nonintubated thoracoscopic lobectomy is technically feasible and is as safe as lobectomy performed with intubation in highly selected patients. It can be a valid alternative of single-lung-ventilated thoracoscopic surgery in managing early-stage NSCLC.
评估非气管插管胸腔镜肺叶切除术的可行性和安全性。
全身麻醉加单肺通气被认为是治疗非小细胞肺癌（NSCLC）胸腔镜肺叶切除术的必备条件。非插管胸腔镜肺叶切除术以前没有报道过。
从 2009 年 8 月到 2010 年 6 月，30 例临床 I 期或 II 期 NSCLC 患者接受了硬膜外麻醉、胸腔内迷走神经阻滞和镇静的非插管胸腔镜肺叶切除术。为了评估该新技术的可行性和安全性，将其与 2008 年 8 月至 2009 年 7 月期间接受插管全身麻醉胸腔镜肺叶切除术的 30 例临床 I 期或 II 期 NSCLC 连续患者进行比较。
非插管组患者通过自主呼吸和迷走神经阻滞，使手术肺萎陷和抑制咳嗽令人满意。由于持续低氧血症、硬膜外麻醉疼痛控制不佳和出血，非插管组中有 3 例患者需要转为插管单肺通气。每组各有 1 例患者因出血转为开胸手术。两组患者的麻醉时间、手术时间、失血量和淋巴结清扫数相当。非插管手术患者的咽痛发生率较低（6.7%比 40.0%，P=0.002），术后恢复经口进食的时间较早（平均 4.7 小时比 18.8 小时，P<0.001）。非插管手术患者的并发症发生率也有较好的趋势（90%比 66.7%，P=0.057），术后住院时间较短（平均 5.9 天比 7.1 天，P=0.078）。
在高度选择的患者中，非插管胸腔镜肺叶切除术在技术上是可行的，与插管肺叶切除术一样安全。它可以作为管理早期非小细胞肺癌的单肺通气胸腔镜手术的有效替代方法。
