National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
J Thorac Cardiovasc Surg. 2022 May;163(5):1702-1714.e7. doi: 10.1016/j.jtcvs.2021.01.093. Epub 2021 Feb 3.
Spontaneous ventilation video-assisted thoracic surgery (SV-VATS) is reported to have superior or equal efficacy on postoperative recovery to mechanical ventilation VATS (MV-VATS). However, perioperative safety of the SV-VATS blebectomy is not entirely demonstrated.
We performed a noninferiority, randomized controlled trial (No. NCT03016858) for primary spontaneous pneumothorax patients aged 16 to 50 years undergoing a SV-VATS and the MV-VATS procedure. The trial was conducted at 10 centers in China from April 2017 to January 2019. The primary outcome was the comparison of intra- and postoperative complications between SV-VATS and MV-VATS procedures. Secondary outcomes included total analgesia dose, change of vital sign during surgery, procedural duration, recovery time, postoperative visual analog pain scores, and hospitalization length.
In this study, 335 patients were included. There was no significant difference between the SV-VATS group and the MV-VATS group in the intra- and postoperative complication rates (17.90% vs 22.09%; relative risk, 0.81; 95% confidence interval, 0.52-1.26; P = .346). The SV-VATS group was associated with significantly decreased total dose of intraoperative opioid agents; that is, sufentanil (11.37 μg vs 20.92 μg; P < .001) and remifentanil (269.78 μg vs 404.96 μg; P < .001). The SV-VATS procedure was also associated with shorter extubation time (12.28 minutes vs 17.30 minutes; P < .001), postanesthesia care unit recovery time (25.43 minutes vs 30.67 minutes; P = .02) and food intake time (346.07 minute vs 404.02 minutes; P = .002). Moreover, the SV-VATS procedure deceased the anesthesia cost compared with the MV-VATS ($297.81 vs $399.81; P < .001).
SV-VATS was shown to be noninferior to MV-VATS in term of complication rate and in selected patients undergoing blebectomy for primary spontaneous pneumothorax.
据报道，自发性通气胸腔镜手术（SV-VATS）在术后恢复方面优于或等同于机械通气胸腔镜手术（MV-VATS）。然而，SV-VATS 疱切除术的围手术期安全性尚未完全证实。
我们进行了一项非劣效性、随机对照试验（编号：NCT03016858），纳入年龄在 16 至 50 岁之间、接受 SV-VATS 和 MV-VATS 手术的原发性自发性气胸患者。该试验于 2017 年 4 月至 2019 年 1 月在中国的 10 个中心进行。主要结局是比较 SV-VATS 和 MV-VATS 手术的围术期并发症。次要结局包括总镇痛剂量、手术期间生命体征变化、手术持续时间、恢复时间、术后视觉模拟疼痛评分和住院时间。
本研究共纳入 335 例患者。SV-VATS 组与 MV-VATS 组的围术期并发症发生率无显著差异（17.90%比 22.09%；相对风险，0.81；95%置信区间，0.52-1.26；P=0.346）。SV-VATS 组术中阿片类药物总剂量明显减少，即舒芬太尼（11.37μg 比 20.92μg；P<0.001）和瑞芬太尼（269.78μg 比 404.96μg；P<0.001）。SV-VATS 组还与拔管时间（12.28 分钟比 17.30 分钟；P<0.001）、麻醉后恢复室恢复时间（25.43 分钟比 30.67 分钟；P=0.02）和进食时间（346.07 分钟比 404.02 分钟；P=0.002）缩短有关。此外，SV-VATS 组的麻醉费用与 MV-VATS 组相比降低（297.81 美元比 399.81 美元；P<0.001）。
在原发性自发性气胸患者的疱切除术方面，SV-VATS 在并发症发生率方面与 MV-VATS 相比非劣效，在某些患者中可能更优。
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