胸腹腔镜食管癌根治术中人工气胸的应用效果分析OACSTPCD
Application effect analysis of artificial pneumothorax in thoracoscopic and laparoscopic radical esophageal cancer surgery
目的:探讨胸腹腔镜食管癌根治术中人工气胸的应用效果.方法:选取 2016 年 8 月至 2023 年 3 月行胸腹腔镜食管癌根治术的86 例患者,将患者按随机数字表法分为对照组(n=43)与观察组(n=43),对照组行双腔管单肺通气,观察组行单腔管双肺通气联合人工气胸;比较两组手术时间、术中出血量、术后清醒时间、术后住院时间及人工气胸或单肺通气前(T1)、人工气胸或单肺通气30 min(T2)、人工气胸或单肺通气60 min(T3)、术后30 min(T4)的PaCO2、PaO2、平均动脉压及心率.结果:观察组术后住院时间短于对照组(P<0.05);T2、T3 时,观察组PaCO2 水平高于T1 时;观察组高于对照组(P<0.05);T2、T3、T4 时,两组PaO2 水平均低于T1 时,观察组高于对照组(P<0.05);T2 时,两组平均动脉压水平均高于T1 时,观察组高于对照组(P<0.05);T2、T3 时,两组心率均高于T1 时,观察组高于对照组(P<0.05).观察组术后并发症总发生率低于对照组[18.60%(8/43)vs.39.53%(17/43),P=0.033].结论:胸腹腔镜食管癌根治术中应用人工气胸对术中呼吸、血流动力学均有影响,术后并发症更少,康复更快.
Objective:To investigate the application effect of artificial pneumothorax on the thoracoscopic and laparoscopic ra-dical surgery for esophageal cancer.Methods:A total of 86 patients who were scheduled to undergo thoracoscopic and laparoscopic radi-cal surgery for esophageal cancer from Aug.2016 to Mar.2023 were collected.All patients were randomly assigned to control group(n=43)and observation group(n=43)using random number table method.The control group received dual-lumen tube single lung ventilation,while the observation group received single lumen tube double-lung ventilation combined with artificial pneumothorax.The surgery time,intraoperative blood loss,postoperative wakefulness time,postoperative hospital stay,and PaCO2,PaO2,mean arterial pres-sure(MAP),and heart rate before artificial pneumothorax or one-lung ventilation(T1),after 30 min of artificial pneumothorax or one-lung ventilation(T2),after 60 min of artificial pneumothorax or one-lung ventilation(T3),and at 30 min after operation(T4)were compared between the two groups.Results:The postoperative hospital stay of the observation group was significantly shorter than that of the control group(P<0.05).In the observation group,PaCO2 levels at T2 and T3 were significantly higher than that at T1,the observa-tion group was higher than the control group.PaO2 levels at T2,T3,and T4 were lower than that at T1 in the both groups,the observation group was higher than the control group(P<0.05).MAP level at T2 was higher than that at T1 in the both groups,the observation group was higher than the control group.Heart rate at T2 and T3 was higher than that at T1 in both groups,the observation group was higher than the control group(P<0.05).The total incidence of postoperative complications in the observation group was lower than that in the control group[18.60%(8/43)vs.39.53%(17/43),P=0.033].Conclusions:The application of artificial pneumothorax in thoraco-scopic and la-paroscopic radical esophageal cancer surgery has an effect on intraoperative respiration and hemodynamics,there are fewer postoperative complications,and the patients can recover faster.
殷优宏;戎国祥;张帆
丹阳市人民医院胸心外科,江苏 丹阳,212300
临床医学
食管切除术胸腔镜检查腹腔镜检查气胸,人工疗效比较研究
EsophagectomyThoracoscopyLaparoscopyPneumothorax,artificialComparative effectiveness research
《腹腔镜外科杂志》 2024 (008)
579-583 / 5
镇江市科技计划项目(SH2021082)
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