喉罩与气管插管麻醉下“三孔式”非肌无力胸腺瘤切除术的对比研究

目的探讨喉罩全身麻醉(全麻)代替气管插管全麻用于经剑突、肋缘下"三孔式"前纵隔病变切除术治疗不合并肌无力的胸腺瘤患者的安全性和可行性。方法纳入我科2018年1月至2019年6月连续收治的行"三孔式"前纵隔病变切除术治疗不合并肌无力的胸腺瘤患者109例。根据麻醉方式不同,将患者分为气管插管全麻组和喉罩全麻组。气管插管全麻组患者共70例,其中男42例、女28例,平均年龄(45.83±15.89)岁;喉罩全麻组患者共39例,其中男26例、女13例,平均年龄(43.31±15.64)岁。比较两组患者的临床资料。结果两组患者基线特征差异无统计学意义(P>0.05)。所有患者均未出现大出血、中转为开胸、术后并发肌无力、死亡等情况。喉罩全麻组患者术中无中转为气管插管全麻者。两组患者在手术时间、术中出血量、术中最高CO2分压、最低氧分压值、麻醉效果评分等方面差异无统计学意义(P>0.05)。两组患者在术后误吸、胃肠道不适、住院时间、疼痛评分、患者满意度等方面差异无统计学意义(P>0.05)。但喉罩全麻组患者手术前麻醉所用时间、麻醉清醒所用时间均明显短于气管插管全麻组患者(P<0.05),而且喉罩全麻组患者术中一过性心律失常、术后咽喉部不适及声音嘶哑发生率均明显低于气管插管组患者(P<0.05)。结论在喉罩全麻下行经剑突、肋缘"三孔式"前纵隔病变切除术治疗不合并肌无力胸腺瘤患者是安全、可行的,可尝试常规推荐使用。

A comparative study of laryngeal mask and tracheal intubation anesthesia for"threeport"thymectomy without myasthenia

Objective To investigate the safety and feasibility of laryngeal mask general anesthesia as a replacement of tracheal intubation general anesthesia in the"three-port"thoracoscopic thymectomy via subxiphoid and subcostal arch for thymoma patients without myasthenia.Methods From January 2018 to June 2019,clinical data of patients with thymoma who underwent the novel"three-port"operation in our institution were analyzed retrospectively.The patients were divided into two groups according to the anesthesia methods,including a tracheal intubation general anesthesia group and a laryngeal mask general anesthesia group.There were 70 patients in the tracheal intubation general anesthesia group,including 42 males and 28 females,with an average age of 45.83±15.89 years.There were 39 patients in the laryngeal mask general anesthesia group,including 26 males and 13 females,with an average age of 43.31±15.64 years.The clinical data of the two groups were compared.Results The baseline characteristics of the patients in the two groups were well balanced(P>0.05).No massive bleeding,conversion to thoracotomy,postoperative myasthenia or death occurred in those patients.No patient with laryngeal mask anesthesia had a conversion to tracheal intubation anesthesia during the operation.There was no significant difference in the operation time,intraoperative bleeding,intraoperative maximum partial pressure of CO2,lowest partial pressure of oxygen and anesthesia effect score between the two groups(P>0.05).There was also no statistical difference in postoperative aspiration,gastrointestinal discomfort,length of hospital stay,pain score and patient satisfaction degree between the two groups(P>0.05).However,the anesthesia time before operation and the time of awake after anesthesia in the laryngeal mask anesthesia group were significantly shorter than those in the tracheal intubation general anesthesia group(P<0.05),and the incidence of transient arrhythmia,laryngeal discomfort and hoarseness in the laryngeal mask general anesthesia group was significantly lower than that in the tracheal intubation general anesthesia group(P<0.05).Conclusion The"three-port"thoracoscopic thymectomy via subxiphoid and subcostal arch under laryngeal mask general anesthesia is safe and feasible in the treatment of thymoma without myasthenia,and can be recommended routinely.