新型冠状病毒肺炎疫情期间单孔胸腔镜在胸部急诊手术中的优势及围手术期处理

目的探讨新型冠状病毒肺炎（新冠肺炎）疫情下单孔胸腔镜急诊手术的优势及围手术期注意事项。 方法回顾性分析涿州市医院在2020年1月至2月新冠肺炎疫情期间6例急诊单孔胸腔镜手术的术前筛查、手术室预防、麻醉、围手术期处理的特点及诊治要点，总结单孔胸腔镜手术的优势。 结果6例患者术前CT及血常规筛查均为阴性，经过术后证实最终均未检出新型冠状病毒感染。急诊手术按照潜在感染进行防护准备，尽量缩短麻醉和手术过程。6例手术胸腔内操作均采用单孔胸腔镜手术，术中另备一套吸引器加强胸腔内烟雾气体吸引。1例行支气管肺修补，4例行肺部分切除术，其中2例合并肋骨骨折的患者加行腔镜辅助下肋骨骨折固定术，1例在全麻双腔气管插管下行单孔胸腔镜下肺叶切除术。术后住院时间平均为5.8 d。无严重并发症发生，但一次性器材及消毒处理的费用较疫情前平均增加约30%。 结论单孔胸腔镜手术具有创伤小、烟雾密闭性好的特点，适宜疫情期间急诊手术采用；疫情期间围手术期预防处理应加强防护等级，即使初次CT及血常规筛查新型冠状病毒感染阴性的患者也应按照潜在感染患者对待。

Application of single-port video-assisted thoracoscopy in emergency thoracic surgery during novel coronavirus pneumonia pandemic: advantages and perioperative management

ObjectiveTo discuss the advantages and perioperative management of single-port video-assisted thoracoscopic surgery (SPVATS) during the novel coronavirus pneumonia (COVID-19) pandemic. MethodsThe characteristics and key points of diagnosis and treatment of six cases of emergency SPVATS performed from January to February 2020 at Zhuozhou City Hospital were analyzed retrospectively. Preoperative screening, protection in operation room, anesthesia, perioperative management, and the advantages of SPVATS were summarized. ResultsScreening CT and routine blood test results were all negative in six patients before operation, and no COVID-19 virus infection was finally detected after operation. Emergency operation was prepared considering the presence of infection. The anesthesia and operation process were shortened as much as possible. All cases were operated by SPVATS. Another set of aspirator was used to strengthen the smoke gas suction, which significantly reduced the formation of smoke or aerosol in the chest cavity. One case underwent bronchopulmonary repair, four cases underwent partial pneumonectomy, of which two cases with rib fracture underwent thoracoscopic assisted rib fixation, and one case underwent SPVATS lobectomy with double lumen endotracheal intubation under general anesthesia. The average postoperative hospital stay was 5.8 days. No serious complications occurred. However, the cost of the treatment increased by about 30% on average. ConclusionSPVATS has the characteristics of minimal invasion and good smoke sealing, which is suitable for emergency operation during the epidemic period. The prevention and treatment in the perioperative period should be strengthened. Even if patients have negative results of preoperative screening CT and routine blood test, they should be treated as potentially infected patients.