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中华胸部外科电子杂志 ›› 2025, Vol. 12 ›› Issue (03) : 119 -129. doi: 10.3877/cma.j.issn.2095-8773.2025.03.01

所属专题: 指南共识

指南与共识

非插管麻醉下食管癌根治术(McKeown)的专家指导意见(2025)
中国食管疾病学会, 广东省胸部疾病学会   
  • 收稿日期:2025-08-16 修回日期:2025-08-26 接受日期:2025-08-28 出版日期:2025-08-28

Expert guidance on radical esophagectomy (McKeown procedure) under non-intubation anesthesia (2025)

Chinese Society of Esophageal Diseases, Guangdong Thoracic Diseases Society   

  • Received:2025-08-16 Revised:2025-08-26 Accepted:2025-08-28 Published:2025-08-28
引用本文:

中国食管疾病学会, 广东省胸部疾病学会. 非插管麻醉下食管癌根治术(McKeown)的专家指导意见(2025)[J/OL]. 中华胸部外科电子杂志, 2025, 12(03): 119-129.

Chinese Society of Esophageal Diseases, Guangdong Thoracic Diseases Society. Expert guidance on radical esophagectomy (McKeown procedure) under non-intubation anesthesia (2025)[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2025, 12(03): 119-129.

本指导意见由中国食管疾病学会与广东省胸部疾病学会联合制定,基于现有文献和参与专家的临床经验,总结出非插管麻醉技术在胸腹腔镜食管癌根治术(McKeown术)中的应用,旨在为有意开展该技术的医疗中心提供参考性建议。本意见系统阐述了非插管麻醉的适应证与禁忌证,强调患者需满足美国麻醉医师协会(ASA)分级≤2、心肺功能良好等条件,并排除严重合并症及气道异常情况。术前准备包括全面评估、营养支持、心肺功能锻炼及饮食调整。麻醉操作技术涵盖硬膜外麻醉、胸椎旁神经阻滞、喉罩置入等,并推荐两种麻醉方案组合以优化术中管理。手术流程详细描述了体位、切口设计及胸、腹、颈部操作要点,强调微创技术优势及自主呼吸管理。麻醉管理重点关注高碳酸血症、低氧血症、喉罩移位等潜在并发症的预防与处理,提出中转气管插管的明确指征。术后镇痛方案采用多模式镇痛策略以减轻疼痛并加速康复。指导意见指出,非插管麻醉具有创伤小、恢复快等优势,但需个体化管理以确保安全。随着技术发展,该技术有望进一步推动食管癌外科的微创化进程。

This guideline is jointly developed by the Chinese Society of Esophageal Diseases and the Guangdong Thoracic Diseases Society. Based on existing literature and the clinical experience of the participating experts, the guideline summarizes the application of non-intubation anesthesia technique in thoracoabdominal laparoscopic esophagectomy (the McKeown procedure), aiming to provide practical references for medical centers that intend to implement the McKeown. The guideline systematically outlines the indications and contraindications of non-intubated anesthesia, emphasizing patient selection criteria such as American Society of Anesthesiologists (ASA) class ≤2 and good cardiopulmonary function, while excluding severe comorbidities or airway abnormalities. Preoperative preparation includes comprehensive evaluation, nutritional support, cardiopulmonary exercise, and dietary adjustments. Anesthetic techniques involve epidural anesthesia, thoracic paravertebral nerve block, and laryngeal mask airway placement, with two recommended anesthesia protocols for optimized intraoperative management. The surgical workflow details patient positioning, incision design, and key steps in thoracic, abdominal, and cervical operations, highlighting the advantages of minimally invasive techniques and spontaneous ventilation management. Anesthesia management focuses on preventing and addressing complications such as hypercapnia, hypoxemia, and laryngeal mask displacement, with clear criteria for conversion to tracheal intubation. Postoperative analgesia adopts a multimodal strategy to enhance recovery. The guideline concludes that non-intubated anesthesia offers advantages of reduced trauma and faster recovery but requires individualized management to ensure safety. With technological advancements, this approach is expected to further promote minimally invasive esophageal cancer surgery.

图1 喉罩置入与确认的标准化流程图。BIS:脑电双频指数
图2 非插管麻醉术中危机管理及中转决策流程图。SpO2:脉搏氧饱和度;FiO2:吸入氧浓度;PaCO2:动脉血二氧化碳分压;SIMV:麻醉机带同步间歇指令通气
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