Analysis of therapeutic effect of single-hole VATS under non-intubated thoracoscopic surgery epidural anesthesia in the treatment of non-small cell lung cancer

doi:10.11958/20250130

Abstract

Abstract:

Objective To investigate the efficacy and safety of non-intubated thoracoscopic surgery in the treatment of non-small cell lung cancer (NSCLC). Methods A total of 180 NSCLC patients were selected and matched by propensity score proximity matching method. Patients were divided into the group A, the group B, the group C and the group D, with 45 cases each. Patients in the group A underwent non-intubated thoracoscopic surgery epidural anesthesia with single operation hole operation, the group B underwent non-intubated thoracoscopic surgery epidural anesthesia with three operation holes, the group C underwent double-cavity tracheal intubation with general anesthesia with single operation hole operation and the group D underwent double-cavity tracheal intubation with three operation holes under general anesthesia. Anesthesia related indexes, surgical related indexes, CD3⁺, CD4⁺, CD4⁺/CD8⁺, 1-second forced expiratory volume (FEV₁), maximal voluntary ventilation (MVV), forced vital capacity (FVC) and complication rate of the 4 groups were compared 1 day before surgery and 1 month after surgery. Results The anesthetic preparation time, first anal exhaust time and first getting out of bed time were shorter in the group A and the group B than those in the group C and the group D, and the dosage of propofol and remifentanil was lower in the group A and the group B than that in the group C and the group D (P<0.05). Compared with the other 3 groups, the group A had the shortest postoperative drainage and hospital stay, and the highest CD3⁺, CD4⁺, CD4⁺/CD8⁺ and FEV₁, FVC and MVV at 1 month after surgery (P<0.05). One month after surgery, CD3⁺, CD4⁺, CD4⁺/CD8⁺, FEV₁, FVC and MVV were lower than 1 day before surgery in the 4 groups. The total incidence of postoperative complications was lower in the group A than that of the other 3 groups (P<0.05). Conclusion Non-intubated thoracoscopic surgery with epidural anesthesia and single operation hole can improve the clinical efficacy of NSCLC patients, reduce the dosage of opioids and have good safety.

Key words: carcinoma, non-small-cell lung, anesthesia, epidural, non-tracheal intubation, single-hole video-assisted thoracic surgery, opioid

CLC Number:

R734.2，R614

Figures/Tables 6

References 19

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组别	男性	年龄/ 岁	体质量指数/（kg/m²）	ASA分级（Ⅰ级/Ⅱ级）	吸烟史
A组	26	57.67±4.36	23.19±1.10	29/16	15
B组	20	57.96±5.38	23.05±0.75	30/15	17
C组	29	59.36±3.82	22.97±0.86	21/24	10
D组	31	58.02±2.89	22.99±0.79	33/12	12
χ²或F	6.334	1.443	1.026	7.489	3.069

组别	男性	年龄/ 岁	体质量指数/（kg/m²）	ASA分级（Ⅰ级/Ⅱ级）	吸烟史
A组	26	57.67±4.36	23.19±1.10	29/16	15
B组	20	57.96±5.38	23.05±0.75	30/15	17
C组	29	59.36±3.82	22.97±0.86	21/24	10
D组	31	58.02±2.89	22.99±0.79	33/12	12
χ²或F	6.334	1.443	1.026	7.489	3.069

组别	麻醉准备时间/min	丙泊酚用量/mg	瑞芬太尼用量/μg	首次肛门排气时间/h	首次下床活动时间/h
A组	23.58±2.89	647.29±111.27	519.11±59.69	8.09±0.95	13.87±1.29
B组	24.16±2.21	651.04±146.55	519.09±54.30	8.07±0.69	14.02±0.97
C组	39.00±3.32^ab	792.60±151.30^ab	610.27±62.36^ab	9.91±1.35^ab	18.91±1.47^ab
D组	38.91±4.18^ab	786.20±134.18^ab	608.20±64.71^ab	9.84±1.40^ab	19.31±1.47^ab
F	20.120^＊＊	2.736^＊＊	1.576^＊	13.057^＊＊	51.488^＊＊

组别	麻醉准备时间/min	丙泊酚用量/mg	瑞芬太尼用量/μg	首次肛门排气时间/h	首次下床活动时间/h
A组	23.58±2.89	647.29±111.27	519.11±59.69	8.09±0.95	13.87±1.29
B组	24.16±2.21	651.04±146.55	519.09±54.30	8.07±0.69	14.02±0.97
C组	39.00±3.32^ab	792.60±151.30^ab	610.27±62.36^ab	9.91±1.35^ab	18.91±1.47^ab
D组	38.91±4.18^ab	786.20±134.18^ab	608.20±64.71^ab	9.84±1.40^ab	19.31±1.47^ab
F	20.120^＊＊	2.736^＊＊	1.576^＊	13.057^＊＊	51.488^＊＊

组别	手术时间/h	术中出血量/mL	淋巴结清扫数/个	术后1d VAS评分/分	术后引流时间/d	住院时间/d
A组	1.98±0.62	87.58±6.39	13.20±1.86	1.24±0.43	3.20±0.66	9.02±2.26
B组	2.04±0.74	89.18±5.92	13.33±1.75	1.27±0.54	3.91±0.63^a	10.73±3.22^a
C组	2.02±0.45	88.53±6.04	14.04±1.59	1.33±0.64	4.24±0.74^a	11.07±3.19^a
D组	2.13±0.79	90.42±7.17	13.91±1.52	1.31±0.47	4.07±0.65^a	10.98±2.51^a
F	0.660	1.169	1.494	0.297	10.126^＊＊	5.770^＊＊