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What treatment is the rapid development of thoracoscopic surgery?

Time:2020-09-10 08:41:27

In the world, thoracoscopic surgery has developed rapidly and popularized rapidly, from the previous diagnosis-based surgery to the treatment-based surgical method. The scope of application involves almost every field of general thoracic surgery, which has become the diagnosis and treatment of a variety of chest diseases.

And does not limit the expertise of the operation time. The thoracoscopic operating table has small openings, small injuries, stable intraoperative life indicators, less impact on physiological indicators, and faster postoperative recovery. It has been widely used in the diagnosis and treatment of common clinical lung diseases. In thoracoscopic surgery, the dual-lumen endotracheal intubation lung isolation technology provides unilateral lung ventilation or separate ventilation of the lungs on both sides, so that the contralateral bronchi and lungs are not contaminated, and the surgical field is fully exposed, thereby enabling minimally invasive thoracoscopic surgery. Provide reliable conditions. One-lung ventilation may produce complications such as hypoxemia, ischemia-reperfusion injury, hypoxic lung injury, mechanical stretch lung injury, ventilator-related lung injury, non-ventilated lung injury. Increasing the fraction of inhaled oxygen and correcting the misalignment of the tube end can prevent and treat hypoxemia; in addition, the lungs can be reduced by applying intravenous anesthetics, suspending the operation and continuing positive airway pressure ventilation to the non-ventilated lungs, and increasing the positive end-expiratory pressure of the ventilated lung Internal shunt rate to improve hypoxemia. When one-lung ventilation is initiated, increase the breathing rate, reduce the tidal volume, and perform pressure-controlled ventilation on the ventilating side lungs to reduce the increase in peak inspiratory pressure, or shorten the one-lung ventilation time to prevent ventilator-related lung injury. However, other complications of unilateral lung ventilation, such as non-ventilated side lung injury, ischemia-reperfusion injury, etc. are difficult to avoid. In recent years, in order to avoid the risks related to tracheal intubation, some foreign scholars have reported the experience of thoracic surgery under pure epidural anesthesia in a conscious state. They confirmed that non-one-lung ventilation anesthesia, some small thoracoscopic surgery can be performed while retaining spontaneous breathing. Later, Taiwan scholars performed thoracoscopic lobectomy with epidural anesthesia combined with intrathoracic vagus nerve block and achieved good results.

However, these non-tracheal intubation anesthesia methods require high technical requirements and require close cooperation between anesthesiologists and surgeons. Recently, the Italian scholar Ambrogi reported 8 cases of lateral laryngeal mask ventilation thoracoscopic surgery for spontaneous pneumothorax. However, the feasibility and safety of this method have not been fully clarified, nor has it been compared with tracheal intubation anesthesia.

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