中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

Tubeless 经剑突下胸腔镜前纵隔肿瘤切除手术的临床应用

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目的 探讨 tubeless 经剑突下胸腔镜前纵隔肿瘤切除手术的安全性、可行性及优越性。 方法 回顾性分析 2016 年 6 月至 2018 年 6 月兰州大学第一医院胸外科前纵隔肿瘤 32 例患者的临床资料,17 例行 tubeless 经剑突下胸腔镜前纵隔肿瘤切除手术,男 8 例、女 9 例,年龄(31.8±8.4)岁;15 例行传统经剑突下胸腔镜前纵隔肿瘤切除手术,男 8 例、女 7 例,年龄(31.1±9.2)岁。对比手术时间、术中最低血氧饱和度(SaO2)、术后清醒时间、术后疼痛视觉模糊评分、术后肺完全复张时间、术后住院时间、住院费用等。 结果 Tubeless 组术后清醒时间[(18.5±1.8)min vs.(28.9±4.2)min,P=0.000]、术后疼痛视觉模糊评分[(1.6±0.6)vs.(3.5±7.4),P=0.000]、术后住院时间[(2.5±7.2)d vs. (4.3±1.1)d,P=0.000]、住院费用[(3.2±1.1)万元 vs.(4.9±1.1)万元,P=0.000]均优于对照组。两组患者手术时间[(51.7±6.5)min vs.(55.1±8.5)min]、术中最低 SaO2(98.5%±0.9% vs. 98.1±0.8)%]、术后肺复张时间[(33.9±12.2)d vs.(38.4±15.2)d]差异均无统计学意义(P>0.05)。 结论 tubeless 经剑突下胸腔镜前纵隔肿瘤切除手术安全可行,并具有显著的优越性。

Objective To discuss the safety, feasibility and advantages of tubeless trans-subxiphoid thoracoscopic surgery in anterior mediastinal tumor resection. Methods A total of 32 patients suffering anterior mediastinal tumor enrolled, including 17 patients (8 males and 9 females) with average age of 31.8±8.4 years who have been performed tubeless trans-subxipohoid tharcoscopic surgery and 15 patients (8 males and 7 females) with average age of 31.1±9.2 years who have been performed traditional trans-subxipohoid tharcoscopic surgery. The differences of surgical duration, the lowest intraoperative arterial oxygen saturation (SaO2), postoperative awaking time, postoperative pain visual analogue score (VAS), postoperative pulmonary recruitment time, duration of postoperative hospital stay and hospitalization cost were analyzed. Results Postoperative awaking time (18.5±1.8 min vs. 28.9±4.2 min, P=0.000), postoperative pain visual analogue score (VAS) (1.6±0.6 vs. 3.5±7.4, P=0.000), duration of postoperative hospital stay (2.5±7.2 d vs. 4.3±1.1 d, P=0.000) and hospitalization cost (3.2±1.1 10 kRMB vs. 4.9±1.1 10kRMB, P=0.000) in the tubeless group were better than them in the control group. There was no significant difference between the two in surgical duration (51.7±6.5 min vs. 55.1±8.5 min), the lowest intraoperative arterial oxygen saturation (SaO2) (98.5%±0.9% vs. 98.1%±0.8%, postoperative pulmonary recruitment time (33.9±12.2 d vs. 38.4±15.2 d)(P>0.05). Conclucion Tubeless trans-subxiphoid thoracoscopic surgery is safe, feasible and advanced in anterior mediastinal tumor resection.

关键词: 自主呼吸麻醉; 加速康复外科; 胸腔镜; 纵隔肿瘤

Key words: spontaneous breathing anesthesia; enhanced recovery after surgery; thoracoscopy; mediastinal tumor

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