Application Of Non-intubated Video-assisted Thoracoscopic Surgery In Radical Resection Of Early Non-small Cell Lung Cance

PurposeIn the past 20 years,Video-assisted thoracoscopic surgery(VATS)has largely replaced the traditional thoracotomy.Since the introduction of double-lumen endotracheal intubation for thoracic surgery anesthesia,thoracic surgery usually uses double-lumen endotracheal intubation for one-lung ventilation anesthesia.However,postoperative complications related to endotracheal intubation may occur,such as pharyngeal and esophageal compression caused by double-lumen endotracheal intubation,lung injury,atelectasis,pneumonia and cardiac dysfunction related to mechanical ventilation,which have a great impact on the recovery of patients’ cardiopulmonary function and prognosis.At present,domestic and foreign studies have proved that the method of preserving spontaneous breathing by laryngeal mask and local nerve block in thoracoscopic surgery can reduce the adverse reactions caused by endotracheal intubation and mechanical ventilation,reduce the length of hospital stay,and improve the prognosis of patients.There are few studies on the perioperative application of non-intubation treatment in thoracoscopic radical resection of lung cancer.In this study,the effects of non-endotracheal intubation and spontaneous breathing anesthesia on postoperative complications and postoperative rehabilitation were analyzed.To investigate the application effect of non-endotracheal intubation preserved spontaneous breathing anesthesia in thoracoscopic lobectomy,and whether it can be used as a more optimal plan for traditional thoracoscopic radical resection of lung cancer under certain conditions.MethodsA total of 165 patients who underwent thoracoscopic radical resection of lung cancer in Clinical Cancer Hospital of Dalian Medical University from May 2018 to September 2020 were retrospectively analyzed.According to the surgical procedures,they were divided into non-endotracheal intubation reserved spontaneous breathing anesthesia(non-intubation VATS)group(33 cases)and traditional thoracoscopy(VATS)group(132 cases).The sample population was 18-70 years old,in good physical condition,able to tolerate thoracoscopic radical resection of lung cancer,able to communicate normally,with tumor diameter ≤3 cm according to preoperative CT examination,without chest wall invasion and mediastinal lymph node enlargement.The postoperative complications,intraoperative conditions and postoperative related indexes were recorded and analyzed.To explore the differences in the therapeutic effects and postoperative pulmonary complications between video-assisted thoracoscopic radical resection of lung cancer without endotracheal intubation and spontaneous breathing anesthesia and traditional video-assisted thoracoscopic radical resection of lung cancer.The resultsA total of 165 patients with single-port thoracoscopic radical resection of lung cancer admitted to our hospital from 2018 to 2020 were retrospectively analyzed.According to the surgical procedures,they were divided into non-endotracheal intubation preserved spontaneous breathing anesthesia single-port thoracoscopic radical resection of lung cancer(33 cases)and traditional general anesthesia single-port thoracoscopic group(132 cases).The incidence of postoperative pulmonary complications was 21.2% in the VATS group and 6.06% in the non-intubated VATS group.The incidence of postoperative pulmonary complications in VATS group was significantly increased,the main manifestations were pulmonary air leakage 6.8%,dyspnea 4.5%,pleural effusion 3.8% and pulmonary infection 3.8%.All patients in VATS group had postoperative sore throat,and the incidence of mild,moderate and severe sore throat was 63.6%,30.3% and 6.0%,respectively.The mode of intubation and pathological stage of VATS are the main factors affecting postoperative pulmonary complications.The incidence of postoperative pulmonary complications in stage IA3 patients was 55.6%,while that in stage IA1 and IA2 patients was 22.2%,with significant statistical difference(P < 0.05).There was no residual tumor in the surgical margin of the two groups,and the tumors were completely resected.There was no significant difference in the short-term efficacy between the two groups.ConclusionNon-intubation VATS is a safe,effective and feasible method for radical resection of early stage non-small cell lung cancer.Non-intubated VATS can reduce postoperative pulmonary complications,accelerate postoperative recovery,and improve patient satisfaction,which can be used as an optimal plan for traditional thoracoscopic radical resection of lung cancer.