人工气胸与支气管封堵器在腔镜McKeown术式治疗老年中下段食管癌中的应用  

Application of artificial pneumothorax and endobronchial blocker in thoracoscopic McKeown surgery in elderly patients with middle-lower esophageal carcinoma

作　　者：刘艳虎 李庆国[1] 李亚东[1] 薛栋[1] LIU Yan-hu;LI Qing-guo;LI Ya-dong;XUE Dong(Cardiovascular Center, the Second Hospital of Nanjing Medical University, Nanjing 210011, China)

机构地区：[1]南京医科大学第二附属医院心血管中心,江苏省南京市210011

出　　处：《实用老年医学》2021年第7期688-691,共4页Practical Geriatrics

摘　　要：目的比较人工气胸与支气管封堵器在腔镜McKeown术式治疗老年中下段食管癌中的应用及对病人围手术期并发症的影响。方法选取2018年1月至2019年12月南京医科大学第二附属医院行腔镜McKeown术式治疗的老年中下段食管癌病人102例,随机分为人工气胸组(AP组,n=50)和支气管封堵器组(BB组,n=52)。记录2组肺萎陷评分、胸腔操作完成时间、胸腔出血量、手术时间、拔管时间、胸腔淋巴结清扫个数、喉返神经损伤例数、围手术期心律失常发生例数、术后谵妄及肺部并发症发生率,并进行组间比较。结果2组胸腔出血量、淋巴结清扫个数、手术时间、喉返神经损伤例数差异无统计学意义(P>O.05)。和AP组相比,BB组肺萎陷评分更低(P<0.05)、胸腔操作时间和拔管时间更短(P<0.05),围手术期心律失常、肺部并发症及术后谵妄发生率更低(P<0.05)。结论支气管封堵器能够比人工气胸提供更好的术野暴露,并降低围手术期心律失常及术后肺部并发症的发生率,可作为腔镜McKeown术式治疗老年中下段食管癌病人的首选气道管理方法。Objective To investigate the application of artificial pneumothorax and endobronchial blocker in thoracoscopic McKeown surgery for mid-lower esophageal carcinoma and the effect on perioperative complications.Methods A total of 102 patients with middle-lower section esophageal cancer were randomly divided into the artificial pneumothorax group(AP group,n=50)and the bronchial blockade group(BB group,n=52).Lung collapse scores,chest operation time,chest blood loss,operation time,extubation time,number of thoracic lymph nodes dissected,cases of recurrent laryngeal nerve injury,cases of perioperative arrhythmia,postoperative delirium and incidence of pulmonary complications were recorded and compared between the two groups.Results There were no significant difference between the two groups in the amount of thoracic hemorrhage,the number of dissected lymph node,the operation time,the number of thoracic lymph rodes dissected,and cases of recurrent laryngeal nerve injury(P>0.05).Compared with AP group,BB group had lower lung collapse score(P<0.05),shorter thoracic operation time and extubation time(P<0.05),and lower incidence of perioperative arrhythmias,pulmonary complications and postoperative delirium(P<0.05).Conclusions Compared with artificial pneumothorax,bronchial blockers can provide better exposure to the operative field,reduce the incidence of perioperative arrhythmia and postoperative pulmonary complications,and can be used as the preferred airway management method for thoracoscopic McKeown surgery for the elderly patients with middle-lower esophageal cancer under indications.

关 键 词：老年人 食管癌 胸腔镜 支气管封堵器 人工气胸 

分 类 号：R735.1[医药卫生—肿瘤]