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  • 张云嵩,杨晨露,陈建,陈田子,黄靖,蒋雷.单孔胸腔镜解剖性肺段切除治疗肺部小病变395例临床分析[J].第二军医大学学报,2019,40(8):827-832    [点击复制]
  • ZHANG Yun-song,YANG Chen-lu,CHEN Jian,CHEN Tian-zi,HUANG Jing,JIANG Lei.Uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy for small pulmonary lesions: a clinical analysis of 395 cases[J].Acad J Sec Mil Med Univ,2019,40(8):827-832   [点击复制]
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单孔胸腔镜解剖性肺段切除治疗肺部小病变395例临床分析
张云嵩1,2,杨晨露1,陈建1,陈田子2,黄靖3*,蒋雷1*
0
(1. 同济大学附属上海市肺科医院胸外科, 上海 200433;
2. 天津中医药大学附属武清区中医院胸外科, 天津 301700;
3. 同济大学附属上海市肺科医院呼吸科, 上海 200433
*通信作者)
摘要:
目的 探讨单孔胸腔镜下解剖性肺段切除治疗肺部良恶性小病变的可行性及安全性。方法 回顾性分析2013年8月至2017年5月同济大学附属上海市肺科医院单一手术组采用单孔胸腔镜进行肺段切除的395例患者的临床资料。其中男性139例、女性256例;平均年龄为(56.25±10.53)岁;左肺193例,右肺202例。采用患者全身麻醉双腔气管插管,于腋前线第4或5肋间取4 cm单孔切口置入胸腔镜及手术器械行解剖性肺段切除术。统计分析左、右两侧肺段切除患者的围手术期资料、术后病理结果、术中中转情况、术后并发症及远期随访结果。结果 本组395例患者中除7例中转为肺叶切除、3例中转开胸、1例由后基底段中转为基底段切除外,其余均顺利完成目标肺段切除。左肺、右肺两侧手术患者在手术时间、术中失血量、病变直径、淋巴结采样个数、术后24 h胸腔引流量、术后插胸腔引流管时间、术后住院时间方面差异均无统计学意义(P均>0.05)。术后病理结果显示恶性病变310例,良性病变85例。术后发生并发症共11例(左肺6例、右肺5例),其中血胸2例、延迟性漏气6例、心律失常3例。无手术死亡病例。随访9~54个月,平均随访时间为(40.06±2.86)个月,所有病例均无术后远期并发症,心肺功能均无异常,本组恶性病变患者均无复发或转移。结论 单孔胸腔镜下解剖性肺段切除安全、可行,可以达到精准、微创的病变部位切除,值得临床推广应用。
关键词:  单孔胸腔镜手术  肺段切除术  肺部小病变  肺肿瘤
DOI:10.16781/j.0258-879x.2019.08.0827
投稿时间:2019-02-02修订日期:2019-04-21
基金项目:
Uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy for small pulmonary lesions: a clinical analysis of 395 cases
ZHANG Yun-song1,2,YANG Chen-lu1,CHEN Jian1,CHEN Tian-zi2,HUANG Jing3*,JIANG Lei1*
(1. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China;
2. Department of Thoracic Surgery, Wuqing Hospital of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301700, China;
3. Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
*Corresponding authors)
Abstract:
Objective To explore the feasibility and safety of uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy in the treatment of benign and malignant small lung lesions. Methods A retrospective analysis was conducted on the clinical data of 395 patients with small pulmonary lesions undergoing uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy by a single surgery group between Aug. 2013 and May 2017 in Shanghai Pulmonary Hospital of Tongji University. Among them, there were 139 males and 256 females, with a mean age of (56.25±10.53) years, and 193 left lung lesions and 202 right lung lesions. The double-lumen trachea cannula was performed under general anesthesia. Thoracoscopy and surgical instruments were inserted through a 4 cm single-hole incision in the 4th or 5th intercostal of anterior line axillary, and anatomical segmentectomy was performed. The perioperative data, postoperative pathology, intraoperative open thoracotomy transit, postoperative complications and long-term follow-up results were statistically analyzed. Results Of the 395 patients, 7 patients were converted to lobectomy, 3 to thoracotomy, 1 to basal pulmonary segmentectomy from posterior basal pulmonary segment, and all the other patients were successfully completed. There were no significant differences in the operation time, intraoperative blood loss, lesion diameter, number of lymph node samples, thoracic drainage at 24 h after operation, postoperative thoracic drainage tube insertion time or postoperative hospital stay between left and right lung lesions (all P>0.05). Postoperative pathology showed malignant lesions in 310 cases and benign lesions in 85 cases. Postoperative complications occurred in 11 cases (6 cases of left lung and 5 cases of right lung), including 2 cases of hemothorax, 6 cases of delayed leakage, and 3 cases of arrhythmia. There were no operative death. The average follow-up time was (40.06±2.86) months, ranging from 9 to 54 months. There were no long-term complications, no abnormal cardiopulmonary function and no recurrence or metastasis in patients with malignant tumors. Conclusion The uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy is safe and feasible, and can resect lesions accurately and minimally invasively. And thus it is worthy of clinical application.
Key words:  uniportal video-assisted thoracoscopic surgery  pulmonary segmentectomy  small pulmonary lesions  lung neoplasms