胸腔镜手术在自主呼吸下进行气管和隆突切除与重建。
Thoracoscopic surgery for tracheal and carinal resection and reconstruction under spontaneous ventilation.
机构信息
Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China.
Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain.
出版信息
J Thorac Cardiovasc Surg. 2018 Jun;155(6):2746-2754. doi: 10.1016/j.jtcvs.2017.12.153. Epub 2018 Feb 21.
OBJECTIVES
To describe and assess the techniques of spontaneous-ventilation video-assisted thoracoscopic surgery (SV-VATS) for tracheal/carinal resections and compare the outcomes with the conventional thoracoscopic intubated method.
METHODS
From May 2015 to November 2016, some 18 consecutive patients with malignant or benign diseases invading distal trachea and carina who met the criteria for SV were treated by SV-VATS resection. To evaluate the feasibility of this novel technique, they were compared with a control group consisting of 14 consecutive patients with the same diseases who underwent VATS resection using intubated general anesthesia from October 2014 to April 2015. Data were collected with a median follow-up of 10.2 months 75 (range: 1-27).
RESULTS
The SV-VATS group consisted of 4 carinal resections and 14 tracheal resections. In the control group, 2 patients underwent carinal resection and 12 underwent tracheal resection. Median operative time was shorter in the SV-VATS group compared with the intubated group (162.5 minutes vs 260 minutes), as was the median time for tracheal end-to-end anastomosis (22.5 minutes vs 45 minutes) and carinal reconstruction (40 minutes vs 86 minutes). The lowest oxygen saturation during the procedure was 94.2% ± 4.9% in SV-VATS group and 93.9% ± 4.5% in the control group. The peak carbon dioxide level at the end of expiration was greater in the SV-VATS group (47.7 ± 4.2 mm Hg vs 39.1 ± 5.7 mm Hg). No conversion to tracheal intubation was needed in the SV-VATS group. Postoperative complications occurred in 6 patients in the SV-VATS group and 9 in the control group. Patients who underwent SV-VATS had a trend toward shorter postoperative hospital stays (11.5 ± 4.3 days vs 13.2 ± 6.3 days). One recurrence (SV-VATS group) and 2 deaths (one in each group) were observed during follow-up.
CONCLUSIONS
SV-VATS is a feasible procedure in tracheal and carinal resection and reconstruction in highly selected patients. It can be a valid alternative to conventional intubated VATS for airway surgery.
目的
描述并评估自主通气电视辅助胸腔镜手术（SV-VATS）在气管/隆突切除术中的技术，并将其结果与传统的胸腔镜插管方法进行比较。
方法
从 2015 年 5 月至 2016 年 11 月，符合 SV 标准的 18 例连续患有恶性或良性疾病侵犯远端气管和隆突的患者接受了 SV-VATS 切除术。为了评估该新技术的可行性，将其与 2014 年 10 月至 2015 年 4 月期间接受插管全身麻醉的胸腔镜 VATS 切除术的 14 例连续患有相同疾病的患者的对照组进行比较。中位随访 10.2 个月（范围：1-27 个月）后收集数据。
结果
SV-VATS 组包括 4 例隆突切除术和 14 例气管切除术。对照组中，2 例患者行隆突切除术，12 例患者行气管切除术。SV-VATS 组的手术时间中位数明显短于插管组（162.5 分钟比 260 分钟），气管端端吻合术（22.5 分钟比 45 分钟）和隆突重建术（40 分钟比 86 分钟）的时间中位数也明显短于插管组。SV-VATS 组术中最低血氧饱和度为 94.2%±4.9%，对照组为 93.9%±4.5%。SV-VATS 组呼气末二氧化碳峰值（47.7±4.2 mmHg）高于对照组（39.1±5.7 mmHg）。SV-VATS 组无需气管插管转换。SV-VATS 组有 6 例患者发生术后并发症，对照组有 9 例。SV-VATS 组患者术后住院时间有缩短趋势（11.5±4.3 天比 13.2±6.3 天）。随访期间，1 例（SV-VATS 组）复发，2 例死亡（每组 1 例）。
结论
SV-VATS 是一种在高度选择的患者中进行气管和隆突切除和重建的可行方法。它可以作为气道手术的常规插管胸腔镜手术的有效替代方法。
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