Background

One-lung ventilation (OLV) is the standard and widely applied ventilation approach used in video-assisted thoracoscopic surgery for esophageal cancer (VATS-e). To address the disadvantages of OLV with respect to difficulties in intubation and induction, as well as the risk of respiratory complications, two-lung ventilation (TLV) with artificial pneumothorax has been introduced for use in VATS-e. However, no studies have yet compared TLV and OLV with postoperative infection and inflammation in the prone position over time postoperatively. Here, we investigated the efficacy of TLV in patients undergoing VATS-e in the prone position.

Methods

Between April 2010 and December 2016, 119 patients underwent VATS-e under OLV or TLV with carbon dioxide insufflation. Clinical characteristics, surgical outcomes, and postoperative outcomes, including oxygenation and systemic inflammatory responses, were compared between patients who underwent OLV and those who underwent TLV.

Results

Clinical characteristics other than pT stage were comparable between groups. The TLV group had shorter thoracic operation time than the OLV group. No patients underwent conversion to open thoracotomy. The PaO₂/FiO₂ ratios of the TLV group on postoperative day (POD) 5 and on POD7 were significantly higher than those of the OLV group. C-reactive protein levels on POD7 were lower in the TLV group than in the OLV group. There were no significant differences with respect to postoperative complications between the OLV and TLV groups. In the TLV group, the white blood cell count on POD7 was significantly lower than that in the OLV group; body temperature showed a similar trend immediately after surgery and on POD1.

Conclusions

In this study, we demonstrated that, compared with OLV, TLV in the prone position provides better oxygenation and reduced inflammation in the postoperative course. Accordingly, TLV might be more useful than OLV for ventilation during esophageal cancer surgery.

中文翻译：

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人工气胸在两肺通气下在食管癌电视胸腔镜手术中的疗效。

背景

单肺通气（OLV）是在食管癌的视频辅助胸腔镜手术（VATS-e）中使用的标准且广泛应用的通气方法。为了解决OLV在插管和诱导困难以及呼吸系统并发症风险方面的缺点，已将带人工气胸的两肺通气（TLV）引入VATS-e。但是，尚无研究将TLV和OLV与术后随时间推移俯卧位的感染和炎症进行比较。在这里，我们调查了TLV在俯卧位接受VATS-e的患者中的疗效。

方法

在2010年4月至2016年12月之间，有119例患者在OLV或TLV下接受了二氧化碳吹气。比较了接受OLV治疗的患者和接受TLV治疗的患者的临床特征，手术结局和术后结局，包括充氧和全身炎症反应。

结果

组间除pT分期以外的临床特征具有可比性。TLV组的胸腔手术时间比OLV组短。没有患者接受开胸手术。术后第5天和第7天，TLV组的PaO ₂ / FiO ₂比值明显高于OLV组。TLV组中POD7的C反应蛋白水平低于OLV组。OLV和TLV组之间在术后并发症方面无显着差异。在TLV组中，POD7上的白细胞计数显着低于OLV组。手术后和POD1上的体温都显示出相似的趋势。

结论

在这项研究中，我们证明，与OLV相比，俯卧位的TLV在术后过程中可提供更好的氧合作用并减少炎症。因此，TLV可能比OLV在食管癌手术期间通气更有用。