单孔全胸腔镜手术：单中心连续106例回顾分析

Uniportal complete video-assisted thoracoscopic surgery: a retrospective analysis of 106 cases of single-institution

摘要:

目的 总结单中心单孔全胸腔镜手术（cVATS）的临床结果，并初步分析手术要点、安全性及可行性。 方法 2012年6月～2013年11月，该科完成106例单孔cVATS手术。肺楔形切除62例，胸膜、纵隔肿瘤切除19例，纵隔淋巴结活检11例，肺叶切除13例（14个肺叶），其中9例肺癌根治术，肺段切除1例。观察其临床结果，并总结单孔cVATS手术技术要点。 结果 全组患者术后无肺不张、肺部感染、出血及肺栓塞等严重并发症，无围手术期死亡。简单胸腔手术无中转，肺叶切除中转开胸2例，中转（双孔腔镜或开胸）率14.3%（2/14）。肺叶切除组平均手术时间191（90～420）min；术中平均出血381（5～3 500）mL；术后平均引流时间2.3（1～6）d；术后平均住院5（3～10）ｄ；肺癌患者清扫平均淋巴结数16.4（6～31）枚，淋巴结站数5.2（4～6）站。 结论 对于熟练掌握双孔cVATS技术的胸外科腔镜医生，单孔cVATS肺叶切除术技术可行，安全，术后胸痛更轻。还需更多病例积累，有必要通过合理安排学习曲线缩短该过程。

Abstract:

【Objective】 To evaluate the safety and technical feasibility of uniportal complete video-assisted thoracoscopic (cVATS) lobectomy. 【Methods】 From June 2012 to November 2013, 106 patients underwent uniportal cVATS procedure including, among which 62 wedge resection, 19 pleural or mediastinal tumor resection, 11 mediastinal lymph node biopsy, 14 lobectomy with 9 lung cancer and 1 segmentectomy. The perioperative data were collected and reviewed. 【Results】 No postoperative severe complications and death occurred. 14.3% (2/14) converted to biportal cVATS or open surgery. Mean surgical time was recorded as 191 (90~420)min and mean blood loss 381 (5~3 500) mL. Mean number of lymph nodes was 16.4 (6~31) and mean number of explored stations was 5.2 (4~6). Overall, the median duration of chest-tube placement was 2.3 (1~6) days, and median length of stay was 5 (3~10) days. 【Conclusion】 Uniportal cVATS is a safe and feasible surgical procedure with less postoperative pain especially when performed by surgeons experienced with biportal technique.