中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

155 例单操作孔解剖性肺段切除临床分析和技术探讨——单中心经验

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目的 探讨单操作孔胸腔镜解剖性肺段切除临应用的可行性和安全性。 方法 回顾性分析 2015 年 1 月至 2016 年 12 月,上海交通大学医学院附属新华医院 155 例单操作孔胸腔镜解剖性肺段切除术患者的临床资料。其中男 62 例,女 93 例,年龄 24–82(平均 53)岁。切口采用 2 孔法,胸腔镜镜头从观察孔进入,手术器械经操作孔进入,肺段血管及支气管使用血管夹(Hemolock)或直线型切割合器处理,段间水平使用直线型切割缝合器分离。分析围手术期各项数据。 结果 1 例患者因肺动脉出血,在增加辅助操作孔下(三孔)缝合止血,其余 154 例患者顺利施行了单操作孔胸腔镜肺段切除手术,无中转开胸,无中转肺叶切除,无围术期死亡。手术时间 65–150(平均 102)min,术中出血量 50–300(平均 118)ml,术后胸腔引流管留置时间 2–7(平均 3.8)d,术后住院时间 3–9(平均 5.6)d。术后并发症 8 例 (5.2%), 其中术后咯血 2 例, 肺部感染 3 例,皮下气肿、胸腔积液、局部肺不张各 1 例, 经对症治疗后痊愈。术后病理结果显示原发性肺癌 139 例(病理分期为 Tis~T1bN0M0),良性病变 9 例,转移性癌 7 例。 结论 单操作孔胸腔镜解剖性肺段切除术安全可行, 可以选择性应用于部分 Ia 期非小细胞肺癌或者不适合肺叶切除术的患者。

Objective To evaluate the feasibility and safety of single utility port video-assisted thoracoscopic surgery (VATS) anatomic segmentectomy for lung diseases. Methods We performed a retrospective review of 155 cases undergoing single utility port VATS anatomic segmentectomy from January 2015 to December 2016. There are 62 males and 93 females with a mean age of 53 years (24–82 years). Two ports were used. The camera was through the port for observation which was about 1.5 cm in length and located at the 7th or 6th intercostal space. The instruments were through port for operation that was about 3–4 cm in length and located at the 4th or 3th intercostal space. Pulmonary segment vessel and segmental bronchi were cut and stitched by Hemolock or linear cut stapler. Different segments was separated by linear cut stapler. Perioperative data was collected and analysed.. Results 1 patient was performed suture under the auxiliary operating hole (three holes) because of pulmonary artery bleeding. The remaining 154 cases underwent single utility port VATS anatomic segmentectomy successfully. No conversion to open procedure or lobectomy was found and there was no perioperative mortality. The median operative time was 102 min (65–150 min) and the median blood loss in operation was 118 ml (50–300 ml). The thoracic drainage time was 3.8 d (2–7 d) and the median hospital stay after operation was 5.6 d (3–9 d). Major morbidity occurred in 8 cases (5.2%) including hemoptysis (in 2 patients), pneumonia (in 2 patients), aerodermectasia (in 1 patient), pleural effussion (in 1 patient) and local atelectasis (in 1 patient). All of them above healed after symptomatic treatment. Patholocal examination showed there were 139 cases of primary lung carcinoma (pathologically staged as Tis ~ T1bN0M0), 9 cases of benign diseases and 7 cases of metastasis tumor. Conclusion Single utility port VATS anatomic segmentectomy procedure is safe and feasible. It can be utilized as an option for those with non-small cell lung cancer staged Ia and those unable to tolerate pulmonary lobectomy

关键词: 单操作孔; 胸腔镜手术; 解剖性肺段切除

Key words: single utility port; video-assisted thoracoscopic surgery; anatomic segmentectomy

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