中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

“双微孔”的三孔胸腔镜肺叶切除术 200 例临床分析

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目的 探讨我科新创的双微孔胸腔镜技术治疗肺癌的临床疗效分析。 方法 回顾性分析 2016 年 9 月至 2018 年 6 月我科 200 例原发性肺癌患者成功实施“双微孔”三孔胸腔镜肺叶切除术的临床资料。手术主操作孔长约 2.0~2.5 cm,副操作孔及观察孔均为 0.5 cm 的微孔,三个切口长度和为 3.0~3.5 cm。 结果 平均手术时间(99.18±21.77)min,术中出血量(170.35±105.12)ml,清扫淋巴结数目(15.82±3.33)个,平均胸腔引流量(446.90±195.32)ml,引流时间(3.67±1.85)d,术后住院日(5.54±2.41)d,中转开胸 7 例,1 例患者因术后并发肺栓塞而死亡,术后并发肺部感染 8 例、漏气>5 d 7 例、心功能不全 5 例、房颤 2 例。 结论 “双微孔”三孔胸腔镜肺叶切除手术是一种安全有效的治疗肺癌的方法,手术创伤小、术后疼痛轻。这一新兴技术可能通过提高患者术后住院期间的舒适度而使患者受益。

Objective Conventional three-port vidio-assisted thoracic surgery (VATS) is well established internationally. Meanwhile, uniportal VATS technique has been become more and more popular in the past decade. However, both methods have their merits and drawbacks. The purpose of this paper is to analyze the surgical outcome of patients with lung cancer using double micro-portal VATS technique. Methods We retrospectively analyzed the perioperative data of two hundred patients with primary lung cancer who underwent successful two micro-portal VATS lobectomy between September 2016 and June 2018 at our unit. The length of the main operating hole was about 2.0 cm–2.5 cm, the size of the secondary operation hole and the observation hole were 0.5 cm individualy. Thus, the total length of the three incisions was 3.0 cm–3.5 cm. Results The mean operating time was 99.18±21.77 min, blood loss was 170.35±105.12 ml, and the mean number of lymph node retrieved was 15.82±3.33. The mean volume and duration of chest tube were 446.90±195.32 ml and 3.67±1.85 days. The postoperative hospital stay were 5.54±2.41 days. Only one patient died of pulmonary embolism after surgery . There were 7 patients which had to transit to thoracotomy. Postoperative pulmonary infection after lobectomy was found in 8 patients. Postoperative air leak over five days was developed in 7 patients. Conclusion The double micro-portal VATS procedure is a safe and effective strategy for patients with lung cancer, which is associated with decreased surgical trauma and less postoperative pain. This emerging technology may benefit patients by enhancing comfort during their postoperative hospitalization.

关键词: 双微孔; 胸腔镜手术; 肺癌; 加速康复外科

Key words: Two micro-portal; vidio-assisted thoracic surgery; lung cancer; enhanced recovery after surgery

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