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目的:探讨局麻与全麻下电视胸腔镜(video-assisted thoracoscopic surgery,VATS)治疗恶性胸腔积液的利弊。方法:自1999年7月至2008年12月,对39例恶性胸腔积液患者实施了VATS,其中8例采用全麻,31例在局麻下进行。对局麻及全麻患者术中生命体征变化、手术时间、疗效、住院费用等进行比较。结果:全组经术前胸穿及术中快速病理诊断均为转移癌性胸水,行VATS-滑石粉喷洒胸膜固定术。局麻平均手术时间20min。手术期间病人的心率较术前平均升高10-20次/min,血压平均升高5-10mmHg,血氧饱和度无明显变化。术后住院时间7-10天。随访1-8个月,平均5个月,胸腔积液均得到控制,未见复发。与控制积液有关的费用较全麻降低了50%。无死亡病例。结论:局麻下VATS治疗恶性胸腔积安全、有效,较全麻下更经济、简便、创伤小、恢复快,对术后呼吸循环功能影响小。
Objective: To investigate the advantages and disadvantages of video-assisted thoracoscopic surgery (VATS) for malignant pleural effusion under local anesthesia and general anesthesia. Methods: From July 1999 to December 2008, 39 patients with malignant pleural effusion were enrolled in VATS, 8 of whom received general anesthesia and 31 under local anesthesia. On local anesthesia and general anesthesia in patients with changes in vital signs, operation time, efficacy, hospitalization costs were compared. Results: All patients underwent preoperative thoracentesis and intraoperative rapid pathological diagnosis of metastatic cancerous pleural effusion, VATS-talc spray pleurodesis. Local anesthetic average operation time 20min. During the operation, the heart rate of the patients increased 10-20 times / min on average compared with that before operation, the average blood pressure increased 5-10mmHg, and the blood oxygen saturation did not change significantly. Postoperative hospitalization time 7-10 days. Follow-up 1-8 months, an average of 5 months, pleural effusion were controlled, no recurrence. The costs associated with controlling effusions are 50% lower than general anesthesia. No deaths. Conclusion: VATS under local anesthesia is safe and effective in the treatment of malignant pleural effusions. It is more economical, simpler, less invasive and faster to recover than general anesthesia. It has little effect on postoperative respiratory function.