Okuda Katsuhiro, Nakanishi Ryoichi
Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
J Thorac Dis. 2016 Nov;8(11):3414-3419. doi: 10.21037/jtd.2016.11.101.
Surgical treatment for lung cancer including airway resection following reconstruction is typically performed under general anesthesia with single-lung ventilation because it is necessary to maintain a sufficient working space and to adjust the airway pressure for the leak test. However, non-intubated thoracic surgery has been gradually developed in recent years for thoracoscopic surgery, due to its lower rate of postoperative complications, shorter hospitalization duration, and lower invasiveness than the usual single-lung anesthesia. Initially, only minor thoracoscopic surgery, including wedge resection for pneumothorax and the diagnosis of solitary pulmonary nodules, was performed under waking anesthesia. However, major thoracoscopic surgery, including segmentectomy and lobectomy, has also been performed under these conditions in some institutions due to its advantages with respect to the postoperative recovery and in-operating room time. In addition, non-intubated thoracic surgery has been performed for tracheal resection followed by reconstruction to fully explore the advantages of this surgical modality. In this article, the merits and demerits of non-intubated thoracoscopic surgery and the postoperative complications, perioperative problems and optimum selection criteria for patients for thoracic surgery (mainly airway surgery) are discussed.
肺癌的外科治疗，包括气道切除后重建，通常在全身麻醉下单肺通气下进行，因为需要维持足够的操作空间并调整气道压力以进行漏气试验。然而，近年来，非插管胸外科手术已逐渐应用于胸腔镜手术，因为与常规单肺麻醉相比，它具有术后并发症发生率低、住院时间短和侵袭性小的优点。最初，只有包括气胸楔形切除术和孤立性肺结节诊断在内的小型胸腔镜手术在清醒麻醉下进行。然而，由于其在术后恢复和手术时间方面的优势，一些机构也在这些条件下进行了包括肺段切除术和肺叶切除术在内的大型胸腔镜手术。此外，非插管胸外科手术已用于气管切除后重建，以充分探索这种手术方式的优势。本文讨论了非插管胸腔镜手术的优缺点、术后并发症、围手术期问题以及胸外科手术（主要是气道手术）患者的最佳选择标准。
