Mukaida T, Andou A, Date H, Aoe M, Shimizu N
Department of Surgery II, Okayama University School of Medicine, Okayama-city, Japan.
Ann Thorac Surg. 1998 Apr;65(4):924-6. doi: 10.1016/s0003-4975(98)00108-8.
Video-assisted thoracic operations usually require single-lung ventilation under general anesthesia. However, for high-risk patients with other underlying pulmonary diseases, one has to consider risks of general anesthesia itself.
Four high-risk patients (4 men; mean age, 73 years) with intractable secondary pneumothorax and other underlying pulmonary diseases were treated by video-assisted thoracic operations under local and epidural anesthesia. Absorbable polyglycolic acid sheets and fibrin glue were used to control the air leakage.
The mean duration of the procedure was 108 minutes. Pain and cough reflex were well controlled, and spontaneous breathing and hemodynamics were well maintained during the operation. The mean duration of the postoperative chest drainage was 5 days. No significant postoperative complication was encountered. No pneumothorax had recurred at a mean follow-up of 16 months.
Video-assisted thoracic operations can be performed safely under local and epidural anesthesia for the treatment of intractable secondary pneumothorax in high-risk patients. The air leakage can be controlled with the use of polyglycolic acid sheets and fibrin glue without bullectomy.
电视辅助胸腔手术通常需要在全身麻醉下进行单肺通气。然而，对于患有其他基础肺部疾病的高危患者，必须考虑全身麻醉本身的风险。
4例患有顽固性继发性气胸及其他基础肺部疾病的高危患者（4名男性；平均年龄73岁）在局部和硬膜外麻醉下接受了电视辅助胸腔手术。使用可吸收聚乙醇酸片和纤维蛋白胶来控制漏气。
手术平均时长为108分钟。术中疼痛和咳嗽反射得到良好控制，自主呼吸和血流动力学维持良好。术后胸腔引流平均时长为5天。未出现明显的术后并发症。平均随访16个月时，气胸未复发。
对于高危患者顽固性继发性气胸的治疗，电视辅助胸腔手术可在局部和硬膜外麻醉下安全进行。使用聚乙醇酸片和纤维蛋白胶无需行肺大疱切除术即可控制漏气。
