中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

超声刀在胸腔镜肺癌手术中的临床应用

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目的 探讨胸腔镜下肺癌手术中超声刀术使用的临床效果,总结术中超声刀应用经验,为规范合理使用超声刀提供指导。 方法 回顾性分析 2017 年 1~3 月浙江大学附属第一医院胸外科行胸腔镜下肺癌手术的 145 例患者的临床资料,观察记录患者手术时间、术中出血量、淋巴结清扫数、术后胸腔引流管放置时间、胸腔引流量、术后住院时间、住院总时间及并发症情况。 结果 在 57 例行胸腔镜下肺癌楔形切除患者中,35 例使用超声刀,超声刀使用组平均手术时间(90.09±43.52)min,术中出血量(21.32±12.75)ml,平均清扫淋巴结(5.12±4.26)个,术后胸腔引流管放置时间(3.15±1.16)d,引流量(535.00±291.69)ml。患者术后住院时间(4.56±1.40)d,总住院时间(10.41±2.76)d,所有患者均无手术并发症。在 88 例行胸腔镜下肺癌肺叶切除术患者中,80 例术中使用超声刀,超声刀使用组平均手术时间为(131.88±41.82)min,术中出血量(42.79±31.62)ml,平均清扫淋巴结术(13.54±8.75)个,术后胸腔引流管放置时间(4.47±2.30)d,引流量(872.09±585.24)ml,患者术后住院时间(5.81±2.26)d,总住院时间(12.23±3.32)d,围术期发生并发症 20 例。 结论 超声刀在胸腔镜下肺癌手术治疗中具有良好的安全性及可靠性,对于术中操作及加快患者术后康复中具有一定的优势。

Objective To evaluate the clinical effects of harmonic scalpel application in lung cancer thoracoscopic surgery, and summarize the experiences of harmonic scalpel operation, which may provide a guidance to the reasonable application of harmonic scalpel. Method We retrospectively analyzed the clinical data of lung cancer patients receiving thoracoscopic surgery from January to March 2017 at the department of thoracic surgery, the First Affiliated Hospital, Zhejiang University. We recorded operation time, total blood loss, the number of lymph nodes resected, duration of chest tube drainage, thoracic drainage, the length of hospital stay, the length of hospital stay after operation and postoperative complications to discuss the effectiveness and safety of harmonic scalpel application. Results In the 57 patients accepted thoracoscopic pulmonary wedge resection, harmonic scalpel was used in 35 patients. The average operation time was (90.09±43.52) min, blood loss was (21.32±12.75) ml, the average number of lymph nodes resected was 5.12±4.26, average duration of chest tube drainage was (3.15±1.16) d, volume of drainage was (535.00±291.69) ml, the length of hospital stay was (10.41±2.76) d, the length of postoperative hospital stay was (4.56±1.40) d, and no postoperative complications were observed. In the 88 patients receiving thoracoscopic pulmonary lobectomy, harmonic scalpel was used in 80 patients. The average operation time was (131.88±41.82) min, blood loss was (42.79±31.62) ml, the average number of lymph nodes resected was 13.54±8.75, average duration of chest tube drainage was (4.47±2.30) d, volume of drainage was (872.09±585.24) ml, the length of hospital stay was (12.23±3.32) d, the length of hospital stay after operation was (5.81±2.26) d, and 20 patients had postoperative complications. Conclusion Harmonic scalpel shows satisfactory effectiveness and safety in lung cancer thoracoscopic surgery. Harmonic scalpel may have advantages in optimizing operative procedure and promoting rapid rehabilitation.

关键词: 超声刀; 胸腔镜; 肺楔形切除术; 肺叶切除术

Key words: Harmonic scalpel; thoracoscopic surgery; pulmonary lobectomy; pulmonary wedge resection

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