单孔全胸腔镜解剖性肺段切除术： 技术细节和初步结果

Uniportal complete video-assisted thoracoscopic anatomic segmentectomy: Technical aspects and initial results

摘要:

目的 总结单孔全胸腔镜（cVATS）肺段切除术的临床结果，并初步分析手术要点、安全性及可行性。方法 2013年12月~2014年4月，该科完成10例单孔cVATS肺段切除术。男8例，女2例；中位年龄57岁（39～71岁）。其中1例同期行右上肺癌根治术，右下肺背段切除术。观察其临床结果，并总结手术技术要点。结果 ９例手术过程顺利，1例右上肺尖后段切除，中转肺叶切除（1/10，10%）。全组无中转双孔、多孔腔镜或开胸手术。平均手术时间（156.1±51）（90～240）min；术中平均出血（49.5±57）（5～200）mL；术后平均引流时间（2.5±1.4）（1～6）d；术后平均住院（5.4±2.3）（3～10）ｄ；肺癌患者清扫平均淋巴结数（14.8±4.1）（10～19）枚，淋巴结站数（5.6±0.89）（5～7）站。1例术后肺复张欠佳，负压吸引好转。全组无术后持续漏气、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。肺癌患者随访1~5个月，未发现复发、转移病例。结论 单孔cVATS肺段切除术技术可行、安全、可重复，术后胸痛更轻。

Abstract:

【Objective】 To evaluate the safety and technical feasibility of uniportal complete video-assisted thoracoscopic (cVATS) segmentectomy. 【Methods】 From December 2013 to April 2014, 10 patients underwent uniportal cVATS segmentectomy including 8 men and 2 women, with a median age 57 (39~71) years. 1 case underwent right upper lobectomy and right lower superior segmentectomy. The perioperative data were collected and reviewed. 【Results】 9 cases underwent uniportal cVATS segementectomy uneventfully. 1 case transferred to lobectomy. No conversion to biportal, triportal or open surgery. Mean surgical time was recorded as (156.1±51) (90~240) min and mean blood loss (49.5±57) (5~200) mL. Mean number of lymph nodes was (14.8±4.1) (10~19) and mean number of explored stations was (5.6±0.89) (5~7). Overall, the median duration of chest-tube placement was (2.5±1.4) (1~6)days, and median length of stay was (5.4±2.3) (3~10) days. In 1 case the reserved lung expanded inadequately postoperatively, which was solved by vacuum suction. No postoperative severe complications and death occurred. Lung cancer patients were followed up for 1-5 months without recurrence or metastasis. 【Conclusion】 Uniportal cVATS segmentectomy is a safe, feasible and reproducible surgical procedure with less postoperative pain.