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全国非气管内插管胸外科手术与麻醉研讨会12月4日在广州附一院顺利闭幕，丁香园记者在会议现场或会后对部分参会者进行了采访，也截取了网上讨论中部分参会医生的发言，供大家参阅。
清醒状态下可视胸腔镜手术治疗自发性气胸
The role of awake video-assisted thoracoscopic surgery
in spontaneous pneumothorax
Objective: We assessed in a randomized study the feasibility and efficacy of awake video-assisted thoracoscopic bullectomy with pleural abrasion to treat spontaneous pneumothorax.
Methods: Between January 2001 and June 2005, a total of 43 patients with primary spontaneous pneumothorax were randomly assigned by computer to undergo videoassisted thoracoscopic bullectomy and pleural abrasion under sole thoracic epidural anesthesia or general anesthesia with single-lung ventilation (control group). Primary outcome measures included technical feasibility and patient satisfaction with anesthesia as scored into 4 grades (from 1, unsatisfactory, to 4, excellent). Secondary outcome measures included global operating room time, assessment of thoracic pain by visual analog pain scale, number of nursing care calls, hospital stay, and recurrences within 12 months.
Results: In the awake group, technical feasibility was scored as excellent, good, and satisfactory in 8, 7, and 6 patients, respectively. Intergroup comparisons (awake versus control) showed that global operating room time (78.0±20.0 vs 105.0±15.0 minutes, P＜.0001), perioperative visual analog pain scale score (2.0±3.0 vs 3.5±2.0, P＝.005), nursing care calls (2.0±1 vs 3.0±3.0, P ＝.017), hospital stay (2.0±1.0 days vs 3.0±1.0 days, P＜.0001), and overall costs (€2540±€352 vs €3550±€435, P＜.0001) were significantly better in the awake group. In the awake group, 5 patients (23.8%) could be discharged within the first 24 postoperative hours. One patient in the awake group and 2 patients in the control group had recurrences within 12 months (difference not significant).
Conclusion: In our study, awake video-assisted thoracoscopic bullectomy with pleural abrasion proved easily feasible and resulted in shorter hospital stays and reduced procedure-related costs while providing equivalent outcome to procedures performed under general anesthesia.
编辑: sy850701 作者:丁香园通讯员
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