Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.
Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
Ann Thorac Surg. 2019 Jun;107(6):1607-1612. doi: 10.1016/j.athoracsur.2019.01.013. Epub 2019 Feb 11.
Nonintubated thoracoscopic surgery for lung tumor is not widely performed. This study assessed the safety, outcome, and risk factors for conversion to tracheal intubation of nonintubated thoracoscopic surgery for lung tumor resection.
We retrospectively reviewed the records of 1,025 patients who underwent lung tumor resection by nonintubated thoracoscopic surgery from August 2009 to December 2016 at our institution. Using univariable and multivariable analyses, we focused on the operative procedures, complications, conversion rate, surgical outcome, and risk factors for conversion to tracheal intubation.
Most patients (73% [n = 748]) were women, and 14.3% (n = 147) of all patients were smokers. The average body mass index was 22.6 kg/m. We performed 315 lobectomies, 111 segmentectomies, and 598 wedge resections. Postoperative complications included prolonged air leak for more than 5 days (20 patients [2%]), arrhythmia (2 [0.2%]), hemothorax (3 [0.3%]), pneumonia (4 [0.4%]), and chylothorax (2 [0.2%]). No surgical deaths occurred. During the operation 20 patients (2%) were converted to tracheal intubation. The main reason for conversion was considerable mediastinal movement. Multivariable analysis revealed that a body mass index of 25 kg/m or higher (p < 0.001) and pulmonary anatomical resection (p < 0.001) were risk factors for conversion to intubation.
Nonintubated thoracoscopic surgery was a safe and effective technique for lung tumor resection. Clinicians should be aware that patients with a body mass index of 25 kg/m or higher or who require pulmonary anatomical resection have a higher risk of conversion to tracheal intubation.
非气管插管胸腔镜手术治疗肺部肿瘤尚未广泛开展。本研究评估了非气管插管胸腔镜手术治疗肺部肿瘤切除的安全性、结果和气管插管的转换因素。
我们回顾性分析了 2009 年 8 月至 2016 年 12 月期间在我院接受非气管插管胸腔镜手术治疗的 1025 例肺部肿瘤患者的病历资料。采用单因素和多因素分析，重点分析手术操作、并发症、中转率、手术结果和气管插管的转化因素。
大多数患者（73%[n=748]）为女性，14.3%（n=147）的患者为吸烟者。平均体重指数为 22.6kg/m。我们进行了 315 例肺叶切除术、111 例肺段切除术和 598 例楔形切除术。术后并发症包括：持续漏气超过 5 天（20 例[2%]）、心律失常（2 例[0.2%]）、血胸（3 例[0.3%]）、肺炎（4 例[0.4%]）和乳糜胸（2 例[0.2%]）。无手术死亡。术中 20 例（2%）患者转为气管插管。转换的主要原因是纵隔运动较大。多因素分析显示，体重指数 25kg/m 或以上（p<0.001）和肺解剖性切除术（p<0.001）是气管插管转换的危险因素。
非气管插管胸腔镜手术是治疗肺部肿瘤的一种安全有效的技术。临床医生应注意，体重指数 25kg/m 或以上或需要肺解剖性切除术的患者气管插管转换的风险较高。
