摘要
[目的]探讨非气管插管保留自主呼吸麻醉下行单孔胸腔镜手术联合Hook-wire针术前定位技术治疗外周型肺磨玻璃样结节的安全性及有效性。[方法]选取2017年12月至2019年12月河南大学第一附属医院收治的60例外周型肺磨玻璃样结节患者为研究对象,进行回顾性分析。所有患者完成Hook-wire术前穿刺定位,转至手术室后在非气管插管保留自主呼吸麻醉下行单孔胸腔镜肺楔形切除术,依据术中冰冻切片病理结果进一步决定手术方案。[结果]所有患者Hook-wire术前穿刺定位成功、手术顺利,无中转气管插管全麻或开胸。其中35例行肺楔形切除术,25例行肺叶切除+淋巴结清扫术(肺癌根治术)。平均麻醉时间(19.27±2.20)min,平均麻醉苏醒时间(11.2±4.08)min,平均手术时间为(63.67±36.44)min,平均术中血气分析PaCO2(44.3±3.65)mmHg,平均术后12 h血气分析PaCO2(41.83±4.54)mmHg,平均术中出血量为(82.5±55.70)mL,平均术后胸管留置时间为(6.5±3.23)d,平均胸管引流总量为(940±674.64)mL,平均术后住院时间为(8.65±3.28)d;围术期未见严重并发症及死亡病例发生;术后常规病理结果与术中冰冻结果完全相符。[结论]非气管插管保留自主呼吸麻醉下行单孔胸腔镜手术联合Hook-wire针术前定位技术治疗外周型肺磨玻璃样结节,能够有效减少手术创伤,降低并发症的发生,缩短术后康复时间,简单易行,安全可靠。同时也实现了对病灶的精准定位,在临床上符合“整体微创”的理念,具有较高的应用价值。
[Objective]To investigate the safety and effectiveness of single port thoracoscopic surgery combined with hook wire needle preoperative localization technology in the treatment of peripheral pulmonary ground glass like nodules under non tracheal intubation and autonomous breathing anesthesia. [Methods]60 patients with peripheral pulmonary ground glass nodule in our hospital from December 2017 to December 2019 were selected as the research objects, and were retrospectively analyzed. All patients completed the hook wire preoperative puncture positioning, and then transferred to the operating room. After being transferred to the operating room, the single port thoracoscopic pulmonary wedge resection was performed under non endotracheal intubation and autonomous breathing anesthesia. The operation plan was further determined according to the pathological results of frozen section during the operation. [Results]All patients were successfully located by hook wire before operation, and the operation was smooth. There was no conversion to general anesthesia or thoracotomy for tracheal intubation. Among them, 35 cases underwent pulmonary wedge resection and 25 cases underwent lobectomy and lymph node dissection(radical resection of lung cancer). The average anesthesia time was(19.27 ± 2.20) min, the average anesthesia recovery time was(11.2 ± 4.08) min, the average operation time was(63.67 ± 36.44) min, the average intraoperative blood gas analysis PaCO2 was(44.3 ± 3.65) mm The average postoperative blood gas analysis PaCO2 was(41.83 ± 4.54) mmHg, the average intraoperative blood loss was(82.5 ± 55.70) mL, the average postoperative chest tube indwelling time was(6.5 ± 3.23) d, the average total thoracic tube drainage was(940 ± 674.64) mL, and the average postoperative hospital stay was(8.65 ± 3.28) d;no serious perioperative complications and deaths occurred;postoperative routine pathological results and intraoperative freezing were observed The results are in perfect agreement. [Conclusion]Conclusion Single port
作者
杨忠信
张丁乾
董彦军
张国瑜
郑先杰
张双林
YANG Zhongxin;ZHANG Dingqian;DONG Yanjun;ZHANG Guoyu;ZHENG Xianjie;ZHANG Shuanglin(Department of thoracic surgery,the First Affiliated Hospital of Henan University,Kaifeng 475000,China)
出处
《河南大学学报（医学版）》
CAS
2020年第6期419-423,共5页
Journal of Henan University:Medical Science
基金
河南省教育厅科学技术研究项目(18A320026)。
关键词
非气管插管
单孔胸腔镜
肺部GGO
整体微创
快速康复
Non endotracheal intubation
Single hole thoracoscope
GGO of lung
Overall minimally invasive surgery
Rapid recovery
