Peng Guilin, Cui Fei, Ang Keng Leong, Zhang Xin, Yin Weiqiang, Shao Wenlong, Dong Qinglong, Liang Lixia, He Jianxing
1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Centre for Clinical Trials on Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Thoracic Surgery, Nottingham City Hospital, Nottingham, NG5 1PB, UK.
J Thorac Dis. 2016 Mar;8(3):586-93. doi: 10.21037/jtd.2016.01.58.
Carinal reconstruction is a difficult technique combined with video-assisted thoracoscopic surgery (VATS). It has a high requirement on the operator's skills in operating thoracoscope and meanwhile requires the close cooperation from anesthesiologists. Tracheal intubation and ventilator-assisted ventilation are key steps to ensure the success of surgery. However, tracheal intubation itself may influence the exposure of surgical field and increase the difficulty of anastomosis. In close cooperation of anesthesiologists, we did not perform tracheal intubation; rather, we carried out non-intubated complete VATS carinal reconstruction in a patient with adenoid cystic carcinoma (ACC) of the lower trachea. The awake complete VATS carinal reconstruction was successfully performed. The anastomosis lasted about 36 hours, and the whole surgical procedure lasted 230 min. The intraoperative blood loss was about 80 mL. The patient recovered well 100 min after surgery. A semi-solid diet began 6 hours following the surgery. This non-intubated anesthesia method makes the surgery easier, especially during the anastomosis of stumps. It is feasible and safe to apply this anesthesia technique in carinal reconstruction.
隆突重建是一项与电视辅助胸腔镜手术（VATS）相结合的难度较大的技术。它对术者的胸腔镜操作技能要求很高，同时需要麻醉医生的密切配合。气管插管和机械通气辅助是确保手术成功的关键步骤。然而，气管插管本身可能会影响手术视野的暴露并增加吻合难度。在麻醉医生的密切配合下，我们对一名气管下段腺样囊性癌（ACC）患者未进行气管插管，而是实施了非插管完全胸腔镜下隆突重建术。成功完成了清醒状态下的完全胸腔镜下隆突重建术。吻合持续约36小时，整个手术过程持续230分钟。术中失血约80毫升。患者术后100分钟恢复良好。术后6小时开始进半流食。这种非插管麻醉方法使手术更易于操作，尤其是在残端吻合时。将这种麻醉技术应用于隆突重建是可行且安全的。
