开胸手术和电视辅助胸腔镜手术(video-assisted thoracic surgery, VATS)均会产生中度至重度以上的术后疼痛,影响患者康复,降低患者的医疗满意度。自1910年诞生以来,VATS以微创的方式逐步应用于肺、纵隔和胸膜等疾病。VATS虽然属于微创手术,疼痛程度明显小于开胸手术,但是术后疼痛程度依旧很高,多数患者难以忍受。镇痛不足可影响患者术后功能恢复和气道分泌物排出,从而导致患者发生局部肺不张、肺炎和肺栓塞等一系列并发症,甚至死亡率增加。因此,VATS的良好术后镇痛至关重要。本文对当前VATS常用术后镇痛的研究进展进行文献总结。Both open thoracic surgery and video-assisted thoracic surgery (video-assisted thoracic surgery, VATS) produce moderate to more than severe postoperative pain, which affects patient recovery and reduces patient medical satisfaction. Since its inception in 1910, VATS has been progressively applied in a minimally invasive manner to diseases of the lung, mediastinum and pleura. Although VATS is a minimally invasive procedure with a pain level significantly lower than that of open-heart surgery, the level of postoperative pain is still high and intolerable for most patients. Inadequate analgesia may affect the postoperative functional recovery and airway secretion discharge, which may lead to a series of complications such as localized pulmonary atelectasis, pneumonia and pulmonary embolism, and even increased mortality. Therefore, good postoperative analgesia for VATS is crucial. In this paper, we summarize the literature on the current research progress of postoperative analgesia commonly used in VATS.
目的总结单术者双孔法在电视辅助胸腔镜手术治疗儿童叶外型肺隔离症中的操作流程,评价此术式临床推广应用的可行性及安全性。方法回顾性收集2020年1月至2023年8月由山东大学附属儿童医院胸外肿瘤外科同一术者完成手术的45例膈肌上型叶外型肺隔离症患者的临床资料。根据手术方式不同分为双孔组(n=15)和三孔组(n=30),其中双孔组患者男11例,女4例,年龄4~19个月,三孔组患者男21例,女9例,年龄3~59个月,通过秩和检验、t检验及Fisher精确检验比较手术时间、术中出血量、住院时间、住院费用及术后并发症发生率等临床参数。结果所有患者均顺利完成手术,未术中中转开放手术。与三孔组相比,双孔组患者的平均住院费用更低(31165元vs 35555元,t=-6.093,P<0.001,手术时间更短(40 min vs 45 min,Z=-2.322,P=0.020),住院时间更短(5 d vs 6 d,Z=-3.519,P<0.001),胸壁切口长度更短(1.0 cm vs 1.6 cm,Z=-5.489,P<0.001)。两组患者术中出血量及术后并发症的发生率差异无统计学意义。结论单术者双孔法在微创电视胸腔镜手术治疗儿童叶外型肺隔离症中操作简便、安全可行,可缩短患者的手术时间及住院时间、减小患者胸壁切口的长度、节省患者的住院费用,更加符合当今加速康复外科的理念,值得临床进一步推广应用。
