摘要
目的探讨70岁以上高龄患者电视胸腔镜手术（vdieo-assisted thoracoscopic surgery,VATS）围术期处理经验。方法1998年5月~2008年5月胸腔镜手术治疗70岁以上患者78例,术前根据患者第1秒用力呼气量（forced expiratoryvolume in first second,FEV1）、一氧化碳弥散量（diffuse capacity of carbon monoxide,DLCO）、超声心动左室射血分数（leftventricular ejection fraction,LVEF）、动脉血气分析、运动试验等结果评估其手术风险。在双腔气管插管全身麻醉下行标准胸腔镜手术（n=46）和胸腔镜辅助小切口手术（n=32）。术后11例延迟拔除气管插管,呼吸机辅助通气以利于麻醉恢复期平稳过渡。结果术后病理：原发性肺癌20例,肺良性病变26例,胸膜间皮瘤3例,胸膜转移癌5例,脓胸5例,纵隔良性肿瘤15例,食管裂孔疝3例,食管平滑肌瘤1例。术后并发症发生率33.3%（26/78）,无术中死亡,围术期死亡率2.6%（2/78）。结论VATS对于高龄患者是一个安全的选择,通过充分的术前准备,选择适当的手术适应证,积极防治术后并发症,可以获得相对良好的治疗效果。
Objective To report our experience on video-assisted thoracoscopic surgery （VATS） and pcrioperative management for patients over 70 years old. Methods From May 1998 to May 2008, 78 patients Over 70 years old were treated by VATS. Operative risk was evaluated by measuring forced expiratory volume in first second （ FEV1 ） , diffuse capacity of carbon monoxide （DLCO） , and left ventricular ejection fraction （LVEF） , and artery blood gas analysis and exercise test before the operation. VATS （n = 46） or video-assisted minithoracotmy （ n = 32） was carried out under general anesthesia with a double-lumen tube. Extubation was delayed in 11 patients after the procedures and mechanical ventilation was employed to smooth anesthesia recovery. Results Postoperative pathological examination showed primary lung cancer in 20 cases, benign pulmonary lesions in 26, pleural mesothelioma in 3, malignant pleural metastasis in 5, empyema in 5, benign mediastinal tumor in 15, hiatal hernia in 3, and esophageal leiomyoma in 1. Postoperative morbidity was 33.3% （26/78） in this series, none of the patients died during the operation; the perioperative mortality was 2.6% （2/78）. Conclusions VATS is safe for elderly patients. Satisfying outcomes can be achieved through strict preoperative evaluation, proper operative method and active management for postoperative complications.
出处
《中国微创外科杂志》
CSCD
2009年第3期265-268,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
高龄患者
电视胸腔镜手术
围术期
Elderly patients
Video-assisted thoracoscopic surgery
Perioperative period
