不同双腔气管插管单侧肺通气的临床效果和解剖学比较

目的探讨在微创胸腔镜术中不同双腔气管插管方法观察手术野肺萎陷和肺通气的效果。方法以患者入院日期单双号不同将120例肺大泡自发性气胸患者分为单左管组60例和左右管组60例,采用不同的气管插管方法,术中观察手术侧肺萎陷程度,术后计算手术时间、出血量、胸腔引流量、肺漏气时间和白细胞计数等指标并进行比较。结果左右管组麻醉中肺的萎陷度达到50%者占48%,肺萎陷度达70%者占32%,而单左管组肺萎陷度达50%和70%者分别占5.00%和93%(P0.01),差异有统计学著意义;单左管组的手术时间和术后反应指标均比左右管组显著降低,P0.01,差异有统计学著意义。结论左侧双腔气管插管在术中控制肺膨胀和维持肺通气方面比右侧气管插管有明显的优势,建议无论左胸或右胸施行胸腔镜手术尽量选择左侧双腔气管插管麻醉。     

电视胸腔镜下胸膜纤维板剥脱术治疗脓胸的手术配合

脓胸外科治疗时间长,疗效差,对肺功能影响大,而开胸手术创伤大,病人痛苦。电视胸腔镜手术治疗视野良好,创伤轻微,久病体弱病人也能很好地耐受,又能与常规手术一样分离胸内粘连,大大缩短疗程,并能最大限度恢复肺功能。 一、临床资料 选取2000年1月～7月,4例脓胸及包裹性胸腔积液病人,均为男性,年龄28～45岁,麻醉采用双腔导管插管麻醉,全组病人均未出现并发症,术后平均住院时间为15天。 二、术前准备 1.器械准备:(1)对于不耐热的器械如分离钳、抓钳用2％戊二醛浸泡,使用前用无菌生理盐水冲洗以消除化学消毒液对     

胸腔镜食管癌根治术中人工气胸与双腔插管临床应用对比分析

目的探讨胸腔镜食管癌根治术采用双腔气管插管和人工气胸单腔插管2种不同插管方法之间的利与弊。方法2014年1月至2015年4月我院胸外科收治90例行胸腔镜食管癌根治术患者,按插管方法的不同分为人工气胸组(A组)和双腔插管组(B组),将2组的气管插管时间、手术时间、肺部感染发生率、术中及术后PaO_2和PaCO_2、吻合口瘘发生率、住院费用、住院时间、术后乳糜胸发生率等进行比较。结果 2组患者术中PaO_2和Pa CO_2、肺部感染发生率、气管插管时间、手术时间、住院时间及住院费用等比较,差异有统计学意义(P0.05)。结论胸腔镜食管癌根治术中人工气胸单腔插管在围手术期管理、费用等方面有一定优势,但是对低氧血症、CO_2潴留及酸碱平衡紊乱等的处理,双腔插管更有优势。     

滑石粉硬化材料在胸腔镜胸膜固定治疗顽固性恶性胸腔积液中的应用

背景:胸腔镜胸膜固定为恶性胸腔积液公认的积极有效治疗手段,硬化剂的优劣直接关系胸膜固定的成功与否,关系到术后的恢复。目的:探讨滑石粉法胸腔镜胸膜固定在顽固性恶性胸腔积液治疗中的作用。方法:纳入顽固性恶性胸腔积液患者29例,其中男14例,女15例,年龄38-79岁,在双腔气管插管静脉复合麻醉下行胸腔镜胸膜固定,硬化剂选择无菌滑石粉,术后观察不良反应情况,术后1个月检查胸部CT,观察胸水量。结果与结论:29例术后均出现胸痛,自行缓解18例,需口服曲马多治疗患者8例,需口服吗啡或注射杜冷丁或吗啡患者3例。术后3 d出现发热者3例。全组无肺水肿、急性呼吸窘迫综合征等严重并发症发生,无死亡病例。术后1个月,治疗有效24例,显效3例,无效2例,总有效率为93%。表明滑石粉法胸腔镜胸膜固定为治疗顽固性恶性胸腔积液一种积极有效的手段。     

规范化双腔支气管导管插管及其就位判定方法的临床应用

目的：评价规范化双腔支气管插管法的临床应用，以及吸痰管通畅试验联合听诊法在插管位置判定中的作用。方法：60例择期行胸外科手术的病人，在麻醉诱导完全后，行规范化双腔支气管插管，并采用吸痰管通畅试验复合听诊法判断双腔管的就位情况。在双腔管就位满意后，再以纤支镜下的准确定位为判定双腔支气管的位置。结果：纤支镜定位双腔支气管导管满意就位率96．6％，无一例发生与双腔管就位不良有关的并发症。结论：吸痰管通试验复合听诊法判断双腔管满意就位的方法简单、可靠，可反复用于术中患者体位变动后对双腔管满意就位状态的判断，且不增加损伤机会，是临床上一个很好的方法。     

老年肺部肿瘤患者手术麻醉期间心律失常原因及处理

目的通过观察分析128例老年肺部手术患者麻醉期间心律失常的发生情况。探讨肺部手术麻醉期间心律失常的发生原因及处理原则。方法麻醉期间采用胸前标准导联连续监测ECG。记录心律失常的发生时间、类型、治疗措施及效果。结果麻醉中共发生各类心律失常106例（82.8%）,经及时处理,绝大多数很快纠正。结果显示老年患者肺部手术麻醉期间易发生心律失常,主要原因包括高龄、全麻双腔气管插管和拔管反应、手术过程中操作刺激、单肺通气时间过长、术前合并心肺疾病、术前心电图异常等。麻醉期间应高度重视。结论老年患者肺部手术麻醉期间心律失常发生率高,术前要进行充分准备,术中要严密监测,以降低围术期并发症和死亡率。     

喉息肉摘除术后护理体会

1.一般资料:全组452例,男275例,女177例,年龄19～58岁,病程10天～25年,以1年～3年为多。主要症状为声嘶。 2.手术方法:均在全麻下插管,高频喷射呼吸机给氧,静脉复合麻醉,麻醉平稳安全,肌松驰满意,声带固定,易充分暴露喉部的病变,由于照明好,加以支撑喉镜放大10倍,该手术准确迅速,彻底。同时可最大限度地避免对喉腔与声带的损伤。熟练的护理配合,是保证手术顺制进行的关键。     

胸腔镜治疗血胸25例体会

目的探讨电视胸腔镜手术处理血胸的适应证与禁忌证。方法对25例血胸在电视胸腔镜下进行手术治疗。其中19例为创伤性血胸,5例为自发性血胸,手术后血胸1例。结果手术时间（40-140）min,平均66min。手术中从胸内清除的血量（800-2200）ml,平均1310ml。术后留置胸腔闭式引流管2-5d,平均2.8d。全组无手术死亡。2例中转剖胸手术,未发生术后并发症。结论电视胸腔镜手术适应于自发性血胸、创伤性血胸、凝固性或包裹性血胸。     

喉罩全麻在高危气管切开中的应用

目的：探讨喉罩全麻高危气管切开术的有效方法,最大限度减少该类气管切开术的风险。方法：回顾分析我科近3年42例在喉罩全麻下进行高危气管切开术患者的临床资料,其中1例颈短肥胖OSAHS患者插管麻醉失败改用喉罩全麻下气管切开插管麻醉,另1例喉气管狭窄强迫体位进行气管切开失败改用喉罩全麻下气管切开插管麻醉;分析利用喉罩全麻下进行高危气管切开术的安全性和适应证。结果：42例中,41例在喉罩全麻下完成高危气管切开术;1例全口无牙齿喉罩全麻失败,改用可视喉镜下插管麻醉完成手术。全组无一例发生严重手术并发症。结论：有选择性地采用喉罩全麻下气管切开术,是降低高危气管切开术风险、提高安全性的有效方法之一,值得推广。     

支气管袖式肺叶切除治疗中央型肺癌的手术技巧和围术期处理

目的探讨支气管袖式肺叶切除治疗中央型肺癌的手术技巧和围术期处理经验。方法回顾分析我院2007年1月至2011年12月收治的中央型肺癌施行支气管袖式肺叶切除术78例,分析术中术后并发症和术后康复情况,总结手术技巧和围术期的处理经验。结果全组均顺利完成手术,其中61例（78．3％）常规开胸手术,17例（21．7％）在胸腔镜辅助下完成。单肺叶切除72例（92．3％）,双Nni-切除6例（7．7％）;联合肺动脉成形18例（23．1％）,其中肺动脉袖式切除3例（3．8％）。全组无手术死亡,术中大出血2例（2．6％）,术后出现支气管胸膜瘘1例（1．3％）,心功能不全3例（3．8％）,各种心律失常13例（16．7％）,肺部感染5例（6．4％）,肺不张6例（7．7％）。所有患者均经积极处理后顺利度过围手术期。结论恰当的术中和围术期处理有利于防治支气管袖式肺叶切除的并发症。胸腔镜辅助支气管袖式肺叶切除具有显露充分和创伤较小等优点。     

Partial removal of the pulmonary artery in video-assisted thoracic surgery for non-small cell lung cancer

Lobectomy with partial removal of the pulmonary artery in video-assisted thoracic surgery (VATS) currently remains a challenge for thoracic surgeons. We were interested in introducing pulmonary vessel blocking techniques in open thoracic surgery into video-assisted thoracic surgery (VATS) procedures. In this study, we reported a surgical technique simultaneously blocking the pulmonary artery and the pulmonary vein for partial removal of the pulmonary artery under VATS. Seven patients with non-small-cell lung cancer (NSCLC) received lobectomy with partial removal of the pulmonary artery using the technique between December 2007 and March 2012. Briefly, rather than using a small clamp on the distal pulmonary artery to the area of invading cancer, we replaced a vascular clamp with a ribbon and Hem-o-lock clip to block the preserved pulmonary veins so as to prevent back bleeding and yield a better view for surgeons. The mean occlusion time of the pulmonary artery and pulmonary veins were 44.0±10.0 and 41.3±9.7 minutes, respectively. The mean repair time of the pulmonary artery was 25.3±13.7 minutes. No complications occurred. No patients showed abnormal blood flow through the reconstructed vessel. There were no local recurrences on the pulmonary artery. In conclusion, the technique for blocking the pulmonary artery and veins is feasible and safe in VATS and reduces the risk of abrupt intraoperative bleeding and the chance of converting to open thoracotomy, and extends the indications of VATS lobectomy.     

Peri-operative management of patients for video assisted thoracoscopic thymectomy in myasthenia gravis

Three patients of myasthenia gravis, who under went video-assisted thoracoscopic surgery (VATS) were given general anaesthesia by propofol infusion and muscle relaxation by atracurium infusion. Isoflurane was added to control depth of anaesthesia on the basis of haemodynamic changes during surgery. One lung ventilation (OLV) was achieved by placement of Carlens left sided double lumen bronchocatheter. Right-sided surgical approach was used to perform thymectomy. Contrary to claimed short duration of surgery, in first patient, OLV lasted for 10 hours 30 minutes and patient developed re-expansion pulmonary oedema. OLV in second and third patient was for six hours thirty minutes and three hours 45 minutes respectively. Morning dose of pyridostigmine was omitted and atracurium (0.1 mg/kg) was found to be satisfactory for intubation and relaxation was maintained with atracurium infusion to get desired monitored effect. We could not extubate our patients due to longer duration of surgery and the sequelae there off. Post-operative elective ventilation and spontaneous weaning off the atracurium effect was thus preferred.     

同期经剑突下单孔胸腔镜双侧肺大疱手术疗效分析

目的：研究分析采用经剑突下入路的单孔胸腔镜手术对双侧肺大疱行同期切除的临床疗效及预后。方法：将2014年1月至2015年12月收治的双侧肺大疱患者70例随机分为观察组和对照组,每组各35例,观察组和对照组分别采用经剑突下、经肋间入路行单孔胸腔镜双侧肺大疱切除术。比较两组患者的手术相关指标、术后并发症发生情况、切口疼痛程度等。结果：70例患者均顺利完成手术,观察组手术时间较短,术后48 h、72 h、第5天疼痛较轻,差异具有统计学意义(P<0.05),出院后随访6个月观察组切口疼痛及麻木的发生率明显低于对照组(P<0.05);而两组术中出血量、胸腔引流管置管时间、胸腔引流量、术后并发症发生率比较均无显著统计学差异(P>0.05)。结论：同期经剑突下单孔胸腔镜双侧肺大疱切除术安全可行,可缩短手术时间,可有效减轻术后疼痛,预后良好。     

右支气管封堵器在胸科单肺通气手术中的应用

目的　评估胸科行右侧肺叶单肺通气手术时,支气管封堵器应用的可行性及安全性。 方法　收集术中需要行右侧肺叶单肺通气的择期胸科手术患者36例,随机分为A、B两组,每组18例,A组插管方法采用传统双腔支气管法,B组采用支气管封堵器法。通过观察插管时间、插管前后生命体征变化、术中肺萎陷的质量、记录插管后、单肺通气20、40、60 min酸碱度（pH）、氧分压（pO2）、二氧化碳分压（pCO2）、及气道压Paw、患者术中出现低氧血症的例数及术后并发症等指标比较两种方法的安全性。 结果　单肺通气后所有患者Paw均升高,但随着时间的延长,B组明显低于A组（P＜0.05）;B术中发生低氧血症及术后发生声音嘶哑等并发症的例数均明显降低（P＜0.05）,差异有统计学意义。 结论　在行右侧肺叶单肺通气的胸科手术中,支气管封堵器法可以解决术中因双腔支气管对位不良而导致术中患者血氧降低的问题,且对气道刺激较小,是一种安全、有效的单肺通气方法。     

完全腔镜下与腔镜辅助小切口食管平滑肌瘤切除术的临床疗效比较

目的比较完全腔镜下与腔镜辅助小切口食管平滑肌瘤切除术的临床效果。方法 56例食管平滑肌瘤患者,其中行完全腔镜下食管平滑肌瘤切除术26例,腔镜辅助小切口食管平滑肌瘤切除术30例,全部采用剥离摘除食管平滑肌瘤,操作方法与开胸手术基本相同。比较两组患者的临床治疗效果。结果两组间一般资料、手术效果比较差异均无统计学意义（P均〉0.05）。所有患者术后恢复顺利,无手术死亡及其它严重并发症,术后病理诊断均为食管平滑肌瘤。随访2-36个月,无肿瘤复发及食管憩室。结论两种手术方式均安全、有效,手术效果无差异,但完全腔镜下较腔镜辅助小切口更安全、快捷,且创伤性小。     

电视胸腔镜手术治疗胸部疾病疗效分析

目的探讨胸腔镜手术疗效及在基层医院开展的可行性。方法收集反应手术疗效的相关指标,比较胸腔镜手术组与传统开胸手术组的差异,评价基层医院开展胸腔镜手术的可行性。结果全组手术时间（100．75±22．72）min,术中出血量（54．27±26．21）mL,术后引流量（920．67±171．99）mL。胸腔镜手术组术后并发症少、住院时间短,且切口操作时间短（P=0．000）、疼痛评分低（P=0．000）,基层医院有能力开展此技术。结论胸腔镜手术疗效好,在基层医院开展具有可行性。     

115例原发性纵膈肿瘤的外科治疗分析

目的探讨原发性纵膈肿瘤外科手术治疗的效果。方法回顾性分析2011年9月至2013年9月我院收治的119例原发性纵膈肿瘤患者的临床资料,115例按手术方法分为2组,45例胸腔镜手术为VATS组,70例常规开放手术为开放组,观察比较2组患者的住院时间、出血量、手术时间等。结果 VATS组的平均手术时间、平均术中出血量、平均住院时间分别为(86.65±53.56)min、(105.13±47.51)mL、(9±7.73)d均优于开放组的平均手术时间、平均术中出血量、平均住院时间(92.35±63.61)min、(148.89±107.42)mL、(11.32±7.20)d,P0.05,差异有统计学意义。结论对于原发性纵膈肿瘤诊断明确后依据肿瘤的大小、部位等优先选择手术治疗,手术成功率高,并发症少,5年存活率高。     

无气管内插管麻醉电视胸腔镜辅助肺切除术后患者快速康复的临床疗效观察

目的 评价无气管内插管麻醉电视胸腔镜手术(VATS)肺切除术后患者快速康复的临床疗效。方法 回顾性队列研究。纳入2018年9月—2020年12月云南省第一人民医院胸外科行肺切除术患者228例,其中男118例、女110例,年龄30~76岁。根据麻醉方式不同分为无插管组(119例)和插管组(109例)。对比观察两组患者的基线资料、手术时间、术中出血量和手术相关并发症情况,以及术后快速康复相关指标,包括术后恢复经口饮食时间、通气时间、下床活动和住院时间、术后胸腔引流量及术后24 h疼痛视觉模拟评分法(VAS)评分等。结果 两组患者年龄、性别、体质量指数(BMI)、病变类型和基础病史等基线资料比较,差异均无统计学意义(P值均＞0.05)。无插管组患者手术时间[120.0(60.0, 150.0)min]、术中出血量[40.0(20.0, 50.0)mL]、术后VAS评分[3.0(3.0, 4.0)分]、术后胸腔引流量[300.0(150.0, 545.0)mL]均低于插管组[130.0(90.0, 175.0)min、50.0(20.0, 100.0)mL、4.0(4.0, 4.0)分、510.0(90.0, 777.5)mL],术后恢复经口进食时间[1.5(1.0, 2.0)h]、下床活动时间[2.0(2, 2.5)h]和通气时间[1.0(1.0, 1.0)d]早于插管组[4.5(4.0, 5.0)h、12.0(10.0, 12.0)h和1.0(1.0, 1.0)d],差异均有统计学意义(Z=-2.229、-3.278、-8.000、-4.019、-13.310、-13.076和-3.297, P值均＜0.05)。两组患者住院时间、术后住院期间及出院后30 d内并发症发生率比较,差异无统计学意义(Z=-0.178, χ²=2.127、3.648, P值均＞0.05)。结论 与插管麻醉相比,无气管内插管麻醉VATS肺切除术后患者早期快速康复的临床效果更好,值得临床外科推广。     

Video-assisted thoracoscopy versus open thoracotomy for spontaneous pneumothorax.

This retrospective study was designed to compare the contribution of the video-assisted thoracoscopic surgery (VATS) and open thoracotomy in the management of spontaneous pneumothorax (SP). The medical records of 100 patients with recurring or persisting (SP) treated were reviewed. The patients were divided into two groups: group I treated by thoracotomy while in group II (VATS) was used. There were 96 men and 6 women aged from 16 to 75 years. Indications for operation and sex distribution were comparable. The mean age for group I was 35 years and for group II was 45 years. Hospital stay was identical in both groups. The amount of narcotic requirements was lesser in group II than in group I as well as the postoperative respiratory dysfunction. There have been no recurrence to date (mean follow-up 6 years for the group I and 3 years for the group II). VATS have been shown to produce results comparable to those obtained following open thoracotomy with reduction of postoperative pain, respiratory dysfunction, catabolic response to trauma and decrease in wound related complications. VATS is a valid alternative to open thoracotomy for primary (SP) but it should be used with caution for the management of secondary pneumothorax.     

Sagittal plane analysis of adolescent idiopathic scoliosis after VATS (video-assisted thoracoscopic surgery) anterior instrumentations

Radiographic sagittal plane analysis of VATS (video-assisted thoracoscopic surgery) anterior instrumentation for adolescent idiopathic scoliosis. This is retrospective study. To report, in details about effects of VATS anterior instrumentation on the sagittal plane. Evaluations of the surgical outcome of scoliosis have primarily studied in coronal plane correction, functional, and cosmetic aspects. Sagittal balance, as well as coronal balance, is important in functional spine. Recently, scoliosis surgery applying VATS has been increasingly performed. Its outcome has been reported several times; however, according to our search of the literature, the only one study partially mentioned. The study population was a total of 42 cases of idiopathic scoliosis patients (8 male, 34 female). Their mean age was 15.6 years (13 to 18 years). The 18 cases were Lenke IA type, 16 cases were Lenke IB type, and 8 cases were Lenke IC type. The preoperative Cobb's angle was 54.5 +/- 13.9 degrees. All patients were followed up for a minimum of 2 years and implanted, on average, at the 5.9 level (5 to 8 levels). The most proximal implant was the 4th thoracic spine, and the most distal implant was the 1st lumbar spine. Whole spine standing PA and lateral radiographs were taken before surgery, 2 months after surgery, and at the last follow up (range 24-48 months, mean 35 months). The C7 plumbline proximal junctional measurement (PJM), distal junctional measurement (DJM), thoracic kyphosis, and lumbar lordosis angles were measured and compared. In all cases, follow-ups were possible and survived till the last follow up. The Cobb's angle in coronal plane at the last follow up was 19.7 +/- 9.3 degrees and was corrected to 63.8% on average. The preoperative C7 sagittal plumbline before surgery was -13.9 +/- 29.1 mm, the final follow up was -9.9 +/- 23.8 mm, and the average positive displacement was 4 mm. Thoracic kyphosis was increased from preoperative 18.2 +/- 7.7 degrees to 22.4 +/- 7.2 degrees on average at the last follow up, and the increase was, on average, 4.2 degrees. The PJM angel was increased from 6.2+/- 4.3 degrees preoperative to 8.8 +/- 3.7 degrees at the last follow up, and the increment was, on the average, 2.6 degrees. The DJM angle before surgery was 6.8 +/- 5.1 degrees and 6.7 +/- 4 degrees at the last follow up, and did not change noticeably. Preoperative lumbar lordosis was 42 +/- 10.7 degrees and 43.5 +/- 11.1 degrees after surgery. Similarly, it did not change greatly. The scoliosis surgery applying VATS displaced the C7 sagittal plumb line by 4 mm to the anteriorly, increased thoracic kyphosis by 4.2 degrees, and increased PJM by 2.6 degrees. DJM and lumbar lordosis, before and after operation, were not significantly different. Although the surgical technique of VATS thoracic instrumentation is difficult to make the normal thoracic kyphosis, an acceptable sagittal balance can be obtained in Lenke type I adolescent idiopathic scoliosis using VATS.