单操作孔胸腔镜手术治疗非小细胞肺癌的临床分析

Clinical analysis of Single utility port video-assisted thoracic surgery in surgical treatment of non-small cell lung cancer

目的探讨单操作孔胸腔镜下行肺叶切除术加系统性淋巴结清扫治疗非小细胞肺癌的可行性和临床应用价值。方法回顾分析2011年3月至2013年3月采用单操作孔胸腔镜行肺叶切除术并且系统性清扫淋巴结治疗的非小细胞肺癌患者42例。手术在腋中线第7或者第8肋间作约1．5cm切口作为观察孔，在腋前线第4或者第5肋间胸大肌外侧缘作4．0—5．0cm切口作为操作孔。结果所有患者均顺利在单操作孔胸腔镜下完成肺叶切除术加系统性淋巴结清扫，无增加第2个操作孔或者中转开胸手术者。行肺叶切除术加系统性淋巴结清扫手术时间90～200min，术中出血量50～400ml，清扫淋巴结数量9～16枚，术后胸腔引流时间5—8d，术后住院6～10d。所有患者均未出现手术并发症，术后恢复良好，顺利出院。结论单操作孔胸腔镜下肺叶切除术加系统性淋巴结清扫治疗非小细胞肺癌，在传统的三孔电视胸腔镜手术基础上进～步减少了手术创伤，具有一定的临床优势，只要病例选择合适，可以作为治疗非小细胞肺癌更微创化的手术方式。

Objective To explore the feasibility and clinical application value of single utility port video-assisted thoracic surgery（VATS） pulmonary lobectomy and systematic mediastinal lymphadenectomy in surgical treatment of non-small cell lung cancer （NSCLC）. Methods We reviewed the clinical data of 42 patients with NSCLC received single utility port VATS pulmonary lobectomy and systematic mediastinal lymphadenectomy from March 2011 to March 2013. The utility port for observation was about 1.5 cm long and located at the 7th and 8th rib in the middle axillmy line. The port for operation was about 4.0-5.0 cm long and located at the 3rd and 4th rib in the outer edge of pectoralis major. Results All of the 42 patients were successfully subjected to single utility port VATS pulmonary lobectomy and systematic mediastinal lymphadeneetomy, none of them needed converse to transit-assisted incision or thoracotomy. Operative duration was 90-200 rain; intraoperrative blood loss was 50-400 ml;lymph node dissection number was 9-16.After the surgery, the patients received chest drainage for 5-8 days. They were discharged from hospital in 6- 10 days after the surgery without severe complications. Conclusions Based on the conventional three utility ports VATS, the single utility port VATS pulmonary lobectomy and systematic mediastinal lymphadenectomy caused less injury in surgical treatment of non-small cell lung cancer （NSCLC）. It has certain clinical advantages and was a minimally invasive surgical treatment for selected patients with NSCLC.