单腔气管插管麻醉在腔镜食管癌Ivor-Lewis手术中的临床应用  

Clinical application of endoscopic Ivor-Lewis esophagectomy under anesthesia with single-lumen endotracheal intubation for esophageal cancer

作　　者：刘玉[1] 王超群[2] 张仁泉[3] 高方方 李媛[4] 高莹华[4] 王煜[1] 胡庆捷 尹斯琪 LIU Yu;WANG Chao-qun;ZHANG Ren-quan;GAO Fang-fang;LI Ruan;GAOYing-hua;WANG Yu;HU Qing-jie;YIN Si-qi(The First Affiliated Hospital of Hainan Medical University,Haikou 570102,Hainan,CHINA;Department of Nuclear Medicine,Hainan Hospital Affiliated to Hainan Medical College,Haikou 570102,Hainan,CHINA;Department of Thoracic Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230000,Anhui,CHINA;Department of Anesthesiology,the First Affiliated Hospital of Hainan Medical College,Haikou 570102,Hainan,CHINA)

机构地区：[1]海南医学院第一附属医院乳胸外科,海南海口570102 [2]海南医学院附属海南医院核医学科,海南海口570102 [3]安徽医科大学第一附属医院胸外科,安徽合肥230000 [4]海南医学院第一附属医院麻醉科,海南海口570102

出　　处：《海南医学》2023年第16期2336-2339,共4页Hainan Medical Journal

基　　金：海南省科技厅重点研发项目(编号:ZDYF2020139);海南省自然科学基金(编号:821MS129)。

摘　　要：目的探讨单腔气管插管麻醉在腔镜食管癌Ivor-Lewis手术中的临床应用效果。方法回顾性分析2019年6月至2022年12月海南医学院第一附属医院乳胸外科收治的76例腔镜食管癌Ivor-Lewis手术患者的临床资料,按麻醉插管方式不同分组,其中38例采用单腔气管插管麻醉者纳入观察组,38例采用双腔气管插管麻醉者纳入对照组。比较两组患者的围术期指标(手术时间、术中出血量、胸管留置时间、平均住院日)、清扫淋巴结总数量及术后并发症发生情况。结果所有患者均在胸腹腔镜下完成手术、R0切除;观察组患者的总手术时间、术中出血量分别为(248.6±32.7)min,(152.3±60.7)mL,明显短(少)于对照组的(273.2±31.6)min、(197.6±55.6)mL,差异均有统计学学意义(P<0.05);观察组患者的平均住院时间及胸管引流时间分别为(14.6±5.4)d,(11.6±2.7)d,略少于对照组的(15.6±5.1)d,(12.3±2.1)d,但差异均无统计学意义(P>0.05);观察组患者清扫淋巴结总数量为(25.6±6.3)枚,明显多于对照组的(20.4±5.7)枚,差异有统计学意义(P<0.05);观察组患者术后并发症发生率为10.5%,略低于对照组的21.1%,但差异无统计学意义(P>0.05)。结论单腔气管插管麻醉下腔镜食管癌Ivor-Lewis手术安全、可行。Objective To explore the clinical application of minimally invasive Ivor-Lewis esophagectomy under anesthesia with single-lumen endotracheal intubation for esophageal cancer.Methods Seventy-six patients with esophageal cancer admitted to the Department of Breast and Thoracic Surgery,the First Affiliated Hospital of Hainan Medical College from June 2019 to December 2022 were retrospectively analyzed.According to the method of anesthesia intubation,they were divided into an observation group(38 cases with single endotracheal intubation anesthesia)and a control group(38 cases with double endotracheal intubation anesthesia).Perioperative indexes(operation time,intraoperative blood loss,thoracic catheter indenture time,average length of hospital stay),total number of lymph nodes dissected,and postoperative complications were compared between the two groups.Results All 76 patients completed the procedure under laparo-thoracoscopy,and all of them were R0 resection.The total operation time and intraoperative blood loss in the observation group were(248.6±32.7)min and(152.3±60.7)mL,which were significantly less than(273.2±31.6)min and(197.6±55.6)mL in the control group(P<0.05).The average length of hospital stay and chest tube drainage time in the observation group were(14.6±5.4)d and(11.6±2.7)d,which were slightly lower than(15.6±5.1)d and(12.3±2.1)d in the control group(P>0.05).The total number of lymph nodes in the observation group was 25.6±6.3,which was significantly higher than 20.4±5.7 in the control group(P<0.05).The incidence of postoperative complications in the observation group was 10.5%,slightly lower than 21.1%in the control group(P>0.05).Conclusion Endoscopic Ivor-Lewis esophagectomy under anesthesia with single-lumen endotracheal intubation for esophageal cancer is safe and feasible.

关 键 词：食管癌 单腔 双腔 气管插管麻醉 胸内吻合 胸腹腔镜 

分 类 号：R735.1[医药卫生—肿瘤]