无管胸腔镜在非解剖性肺切除中的临床应用

目的：总结探讨无管胸腔镜技术在非解剖性肺切除手术中的应用。方法：回顾性总结我科从2017年5月以来进行的无管胸腔镜非解剖性肺切除手术患者的情况，手术过程中不做气管插管、保留患者的自主呼吸，以胸段硬膜外阻滞或肋间神经阻滞止痛，以异丙酚、瑞芬太尼等药物镇静、控制呼吸。结果：无管胸腔镜进行非解剖性肺切除手术29例，其中肺大泡切除24例，肺部结节肺楔形切除3例，肺大泡切除合并肺部结节楔形切除1例，肺部肿物局部切除合并隆突下淋巴结活检1例。术中无中转气管插管麻醉，无中转开胸手术。术后除一例80岁患者出现心衰外，其余患者均恢复满意。结论：无管胸腔镜进行非解剖性肺切除手术安全性可靠，操作简单，恢复快，值得进一步推广。

Application of non-intubated video-assisted thoracoscopic surgery in non-anatomic pulmonary resection

Objective: to evaluate the usefulness of non-intubated video-assisted thoracoscopic surgery (NIVATS) in non-anatomic pulmonary resection. Methods: The patients who underwent NIVATS for non-anatomic pulmonary resection from May 2017 were retrospectively reviewed. During the operation, non-intubated general anesthesia with spontaneous breathing was performed. Thoracic epidural block or intercostal nerve block was used as an analgesic method. Sedation was achieved using propofolSand remifentanilSwere used to control breathing. Results: totally 29 patients undergoing NIVATS for non-anatomic pulmonary resection were included in this study. 24 of the patients underwent bullectomy, 3 of wedge resection for nodule, 1 of bullectomy combined wedge resection for nodule, and one mass resection combined subcarinal lymph node biopsy. No patient transfer to tracheal intubation anesthesia or thoracotomy. All the patients recovered uneventfully except an 80-year-old patient undergoing heart failure after surgery. Conclusion: There was enough safety with the NIVATS for non-anatomic pulmonary resection. This method deserved to be popularized because it is simple and patients recovered quickly.