Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Department of Surgery, Division of Thoracic Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2020 Oct;83(10):943-949. doi: 10.1097/JCMA.0000000000000408.
Nonintubated video-assisted thoracic surgery (VATS) is widely used due to its acceptable postoperative outcomes. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) has been successfully applied in cases of prolonged difficult intubation and intensive respiratory care in patients receiving VATS lobectomy. Thopaz Digital Chest Drainage System (THOPAZ) provides regulated negative pressure close to the patient's chest, optimizing drainage of the pleural and mediastinum. We explored the surgical outcomes of nonintubated VATS lung wedge resection and traditional wedge resection with a double-lumen endotracheal tube.
Patients who received nonintubated VATS lung wedge resection (group A, n = 81) and traditional wedge resection with double-lumen endotracheal tube (group B, n = 79) during the period of November 2015 to April 2018 were enrolled in the study. Demographic data and operation outcomes were obtained and analyzed from review of patient medical charts.
Group B had significantly longer mean induction and operative times than group A. Similarly, group B suffered greater intraoperative blood loss, longer postoperative hospital stays, and increased chest tube retention times than group A. Group A had higher partial pressure of carbon dioxide levels in both the pre-one-lung and during one-lung ventilation periods than group B. Furthermore, group A showed lower serum pH levels during one-lung ventilation period. However; group A had significantly higher partial pressure of oxygen levels during one-lung ventilation than group B, although the differences in peripheral oxygen saturation were not statistically significant.
Our study demonstrated that nonintubated VATS using THRIVE and THOPAZ in lung wedge resection provides measurable benefits to patients.
非插管视频辅助胸腔手术（VATS）因其术后结果可接受而被广泛应用。经鼻湿化快速充气交换通气（THRIVE）已成功应用于 VATS 肺叶切除术患者长时间困难插管和强化呼吸治疗的病例。Thopaz 数字胸腔引流系统（THOPAZ）可提供接近患者胸部的调节负压，优化胸腔和纵隔引流。我们探索了非插管 VATS 肺楔形切除术和传统双腔气管插管楔形切除术的手术结果。
我们回顾性分析了 2015 年 11 月至 2018 年 4 月期间接受非插管 VATS 肺楔形切除术（A 组，n=81）和传统双腔气管插管楔形切除术（B 组，n=79）的患者的临床资料。比较两组患者的一般资料和手术结果。
B 组的平均诱导时间和手术时间明显长于 A 组。同样，B 组术中出血量较多，术后住院时间较长，胸腔引流管留置时间也较长。与 B 组相比，A 组在单肺通气前和单肺通气期间的二氧化碳分压更高。此外，A 组在单肺通气期间的血清 pH 值较低。然而，A 组在单肺通气期间的氧分压明显高于 B 组，尽管外周血氧饱和度的差异无统计学意义。
本研究表明，非插管 VATS 采用 THRIVE 和 THOPAZ 进行肺楔形切除术可为患者带来显著获益。
