3D胸腔镜非插管全身麻醉下混合剑突右侧肋间入路胸腺扩大切除术应用于22例患者回顾性分析

Retrospective Analysis of 22 Cases of 3D Thoracoscopy Nonintubation General Anesthesia Mixed Right Intercostal Approach Thymectomy

摘要: 目的：探讨3D胸腔镜非插管全身麻醉下混合剑突右侧肋间入路胸腺扩大切除术应用于临床的可行性及综合效果，重点评价其在微创性、加速患者术后康复以及优化护理工作方面的价值。方法：采用回顾性分析方法，选取2023年5月至2025年6月期间接受3D胸腔镜非插管全身麻醉下混合剑突右侧肋间入路胸腺扩大切除术的22例患者作为研究对象。收集并分析患者的临床资料，包括手术时间、术中出血量、术后疼痛评分(如VAS评分)、住院天数、皮肤损伤等并发症发生率，同时评估该术式对术中体位摆放时间、护士术中配合复杂度等护理工作的影响。结果：与传统术式相比，应用3D胸腔镜非插管全身麻醉下混合剑突右侧肋间入路胸腺扩大切除术的22例患者手术均顺利完成，无中转开胸，无输血病例。结果显示：1) 微创效果显著：患者手术时间平均为88分钟，术中出血量平均为9 ml，术后疼痛评分平均为2分；2) 加速康复突出：患者平均住院日平均为3.8天；3) 护理优化明显：术中体位摆放平均时间为6分钟，体位摆放更简便、安全，未发生相关皮肤损伤及肢体神经损伤，减轻了护士的工作负荷，提高了手术室周转效率。结论：3D胸腔镜非插管全身麻醉下混合剑突右侧肋间入路胸腺扩大切除术的新入路方式充分暴露术野，降低手术难度，手术时间缩短，不仅具有确切的微创优势和显著的加速康复效果，能有效改善患者预后，同时通过优化手术流程(特别是体位管理)显著提升了护理工作效率。该术式是一种值得推广的、能够实现“患者–医护”双赢的优化外科技术。

Abstract: Objective: To investigate the feasibility and comprehensive effect of 3D thoracoscopy combined with right intercostal approach for thymectomy under general anesthesia without intubation, and to evaluate its value in minimally invasive operation, accelerating postoperative recovery and optimizing nursing work. Methods: A retrospective study was conducted on 22 patients undergoing 3D thoracoscopy-assisted non-intubation general anesthesia combined with right intercostal approach for thymectomy between May 2023 and June 2025. Clinical data were analyzed, including operative duration, intraoperative blood loss, postoperative pain scores (e.g., VAS), hospitalization duration, and incidence of complications such as skin injuries. The study also evaluated the impact of this surgical technique on nursing aspects, particularly the duration of patient positioning and the complexity of nursing collaboration during the procedure. Results: Compared with conventional surgical approaches, all 22 patients undergoing 3D thoracoscopy-assisted non-intubation general anesthesia with a mixed right xiphoid intercostal approach for thymectomy achieved successful outcomes without requiring thoracotomy or blood transfusion. Key findings included: 1) Remarkable minimally invasive outcomes: Average surgical time was 88 minutes, intraoperative blood loss averaged 9 ml, and postoperative pain scores averaged 2 on a 10-point scale; 2) Prominent accelerated recovery: The average hospital stay was 3.8 days; 3) Significant nursing optimization: The average positioning time during surgery was 6 minutes, with safer and more convenient positioning techniques. No skin or limb nerve injuries were observed, which reduced nurses’ workload and improved operating room turnover efficiency. Conclusion: The novel 3D thoracoscopy-assisted non-intubation general anesthesia combined with right intercostal approach for thymectomy provides comprehensive surgical exposure, reduces operative complexity, and shortens operation time. This minimally invasive technique demonstrates clear advantages in reducing trauma and accelerating postoperative recovery, significantly improving patient outcomes. By optimizing surgical procedures (particularly posture management), it also enhances nursing efficiency. As a clinically viable surgical technique, this approach achieves a win-win outcome for both patients and healthcare providers.