Clinical Study Of Minimally Invasive Radical Surgery For Esophageal Cancer With Different Visualization Lung Isolation Techniques

BackgroundEsophageal cancer is one of the most common malignant tumors in China,and it is usually treated by surgery.At present,the main surgical technique is minimally invasive esophagectomy(MIE),which is a small trauma and light pain,but the surgery is difficult.One lung ventilation(OLV)and Postoperative pulmonary complications(PPCs)were higher.With the promotion of enhanced recovery after surgery,anesthesiologists are constantly looking for suitable airway management solutions to protect the airway,maintain circulation stability,reduce PPCs and improve patient prognosis.The study found that visual lung isolation technology is safer and more convenient to manage during thoracic surgery,which includes video double-lumen tubes and video bronchial obstructions.Video double-lumen tubes are currently used in many clinical applications,and can be quickly and accurately positioned without the use of a fiberoptic bronchoscope(FOB).The entire airway is visually managed during the operation.Video bronchial obstruction is a new type of visualized airway management technology that has appeared in recent years.It consists of a video single lumen tube combined with an obstruction.Previous studies have focused on the comparison of intubation stress between the two.There are few studies on the impact of these two visualized lung isolation techniques on intraoperative lung ventilation and ventilation function during OLV,and the occurrence and outcome of PPCs.ObjectiveThis study mainly explored the impact of the use of video double-lumen bronchial tubes and video bronchial obstructions on intraoperative pulmonary lung ventilation and exchange oxygenation functions,and the occurrence and outcome of PPCs in MIE patients.Provide reference for clinical.MethodSelected 64 patients who choose MIE electively,ASA grade Ⅰ or Ⅱ,aged 45～65 years,divided into two groups according to the random number table method,respectively,can be seen video bronchial obstruction group(Group B)and video double-lumen bronchial tube group(Group D).Intubation was performed using a video bronchial obstruction or a video double-lumen bronchial tube.Observe intubation indicators:record intubation time,positioning time,total intubation positioning time,Intubation depth,lateral and lateral tube displacement,incidence of tube displacement during surgery,FOB utilization rate.Hemodynamic indicators:before and after intubation(T0),3min(T1),OLV30min(T2),OLV60min(T3),OLV end 30min(T4),and end of surgery(T5)Heart rate(HR),and mean arterial pressure(MAP).Index of lung isolation:record the impact of lung collapse at 0 min,5 min,10 min,and 20 min after pleura opening during surgery.Record the airway plateau pressure(Pplat)at T1-T5.Blood gas analysis indicators:extract arterial blood at T1-T5 for blood gas analysis,record the pH value,PaO2,PaCO2 at each time point of the two groups.Intrapulmonary shunt rate(Qs/Qt),respiratory index(RI),and oxygenation index(OI)of patients at T5.Intraoperative conditions:record the operation time,thoracic operation time,extubation time,bleeding volume,and rehydration volume.Postoperative indicators:incidence of sore throat and hoarseness at 3 days after operation,pulmonary complications(pneumonia,atelectasis,hypoxemia)at 7 days after operation,the incidence of ICU and mortality.Result1.A total of 64 patients were included in this study.Finally,the study was completed and 60 patients were included in the experimental analysis,30 in each group.There was no statistically significant difference in general data between the two groups of patients(P>0.05);2.Compared with group D,group B had slower intubation time and faster positioning time,shallow intubation,short total intubation positioning time and the difference was statistically significant(P<0.05).There were no statistically significant differences in the lateral displacement rate of catheter placement,FOB utilization rate,and intraoperative catheter displacement rate between the two groups(P>0.05).3.Compared with T0,HR and MAP were significantly increased at T1 in both groups(P<0.05);there was no significant difference in T2-T5(P>0.05);compared with group D,In group B,HR and MAP were high at T1(P<0.05).4.There was no significant difference in the degree of lung collapse between the two groups at 0 min,5 min,10 min,and 20 min after pleura opening(P>0.05).5.Compared with T1,Pplat increased at T2-T4 at the time of T2-T4(P<0.05);compared with group D,Pplat at T2-T4 at the time of Group B was lower than that of the D group(P<0.05).6.Compared with T1,Qs/Qt and RI increased at T2-T5,and OI decreased(P<0.05);compared with group D,Qs/Qt at group T2-T4,RI value was lower than group D,OI value was higher than group D(P<0.05).7.Compared with T1,PaO2 and pH were decreased at T2-T5,and PaCO2 was increased in both groups(P<0.05);compared with group D,PaO2 was in group B at T2-T4.The pH value was higher than group D,PaCO2 was lower than group D at T2-T4(P<0.05).8.Compared with group D,operation time and extubation time of group B were faster than that of group D(P<0.05);rehydration,volume bleeding,the operation time,were not significantly different(P>0.05).9.Compared with group D,the incidence of postoperative sore throat,hoarseness,and pulmonary complications was lower in group B(P<0.05);There was no significant difference in ICU transfer rate(P>0.05);there were no deaths in either group.ConclusionPatients with minimally invasive esophageal cancer undergoing lung isolation with video bronchial obstruction can obtain a lower plat airway pressure,which can more effectively improve the patient’s oxygenation,reduce intrapulmonary shunt,reduce pulmonary complications and protect lung function.