Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita Kashiwashi, Chiba, 277-8567, Japan.
Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita Kashiwashi, Chiba, 277-8567, Japan.
Asian J Surg. 2023 Oct;46(10):4208-4214. doi: 10.1016/j.asjsur.2022.11.103. Epub 2022 Dec 8.
This study evaluated the feasibility of performing non-intubated video-assisted thoracoscopic surgery (VATS) with local anesthesia for parapneumonic effusion and empyema resistant to conservative treatment.
We retrospectively reviewed 80 patients who underwent surgery for parapneumonic effusions and empyema between 2015 and 2021. Patients were divided into those who received non-intubated local anesthesia and general anesthesia during surgery. Patient demographics, characteristics, laboratory findings, treatment progress, and treatment outcomes were compared. The primary outcomes were duration of postoperative drainage, postoperative complication rate, and postoperative mortality rate within 30 days.
Among patients who received local (n = 21) and general anesthesia (n = 59), there was a significant difference in age (median 79.0 years [interquartile range (IQR) 77.0-80.0] vs. 68.0 years [IQR 54.5-77.5]; p < 0.001), preoperative performance status (3.0 [IQR 2.0-4.0] vs. 2.0 [IQR 1.0-3.0]; p < 0.001), and operative time (69 min [IQR 50-128] vs. 150 min [IQR 107-198]; p < 0.001) but not in preoperative white blood cell count (12,100/μL [IQR 8,400-18000] vs. 12,220/μL [IQR 8,950-16,724]; p = 0.840), C-reactive protein (15.2 mg/dL [8.8-21.3] vs. 17.9 mg/dL [IQR 9.5-23.6]; p = 0.623), postoperative drainage period (11 days [IQR 7-14] vs. 9 days [7-13]; p = 0.216), postoperative hospital stay (22 days [IQR 16-53] vs. 18 days [IQR 12-26]; p = 0.094), reoperation rate (9.5% vs. 15.3%; p = 0.775), postoperative complication rate (19.0% vs. 18.6%; p = 0.132), or postoperative 30-day mortality rate (4.8% vs. 0%; p = 0.587).
VATS using local anesthesia is feasible for patients with treatment-resistant parapneumonic effusion and empyema with poor general condition.
本研究评估了局部麻醉下非插管视频辅助胸腔镜手术（VATS）治疗保守治疗无效的脓胸和脓胸的可行性。
我们回顾性分析了 2015 年至 2021 年间接受脓胸和脓胸手术的 80 例患者。患者分为术中接受非插管局部麻醉和全身麻醉的两组。比较患者的人口统计学、特征、实验室检查、治疗进展和治疗结果。主要结局为术后引流时间、术后并发症发生率和术后 30 天内死亡率。
接受局部麻醉（n=21）和全身麻醉（n=59）的患者在年龄（中位数 79.0 岁[四分位距（IQR）77.0-80.0] vs. 68.0 岁[IQR 54.5-77.5]；p<0.001）、术前体能状态（3.0[IQR 2.0-4.0] vs. 2.0[IQR 1.0-3.0]；p<0.001）和手术时间（69 分钟[IQR 50-128] vs. 150 分钟[IQR 107-198]；p<0.001）方面存在显著差异，但在术前白细胞计数（12100/μL[IQR 8400-18000] vs. 12220/μL[IQR 8950-16724]；p=0.840）、C 反应蛋白（15.2mg/dL[8.8-21.3] vs. 17.9mg/dL[IQR 9.5-23.6]；p=0.623）、术后引流时间（11 天[IQR 7-14] vs. 9 天[7-13]；p=0.216）、术后住院时间（22 天[IQR 16-53] vs. 18 天[IQR 12-26]；p=0.094）、再次手术率（9.5% vs. 15.3%；p=0.775）、术后并发症发生率（19.0% vs. 18.6%；p=0.132）或术后 30 天死亡率（4.8% vs. 0%；p=0.587）方面无显著差异。
对于一般情况较差的治疗抵抗性脓胸和脓胸患者，使用局部麻醉的 VATS 是可行的。
