单操作孔全腔镜肺癌根治术113例分析

Analysis of Single-operation-hole Thoracoscopic Lobectomy in 113 Clinical Cases

背景与目的胸腔镜肺叶切除术治疗肺癌已经被广泛接受,本研究探讨单操作孔全腔镜下非小细胞肺癌根治术的可行性。方法回顾性研究分析本院2010年10月至2013年10月共为113例非小细胞肺癌患者施行单操作孔全腔镜肺癌根治术。胸腔镜观察孔取腋中线后侧第8肋间,切口约1.5 cm,操作孔取腋前线第4或5肋间,切口长约2 cm-4 cm,经单一操作孔完成胸腔内手术操作。结果全组患者手术顺利,无围手术期死亡,其中5例患者因术中大出血行操作孔撑开;平均手术时间(178.24±31.37)min,平均术中失血(213.56±62.38)mL,术中清扫淋巴结5枚-22枚。3例患者因术后并发症再次行胸腔镜下手术,其中2例为迟发性出血,1例为乳糜胸。全组患者术后病理均证实肺癌诊断,术后平均住院时间(8.17±2.93)d。术后患者均顺利恢复,随访2个月-38个月仅5例出现复发或转移。结论单操作孔全腔镜肺癌根治术安全可行,进一步降低了创伤,可以作为早中期非小细胞肺癌的一种常规手术方式。

Background and objective Video-assisted thoracoscopic surgery （VATS） lobectomy is generally ac-cepted for patients with lung cancer. hTe aim of this study is to explore the feasibility of the single-operation-hole thoraco-scopic lobectomy in the treatment of non-small cell lung cancer. Methods To review and analyze the single-operation-hole thoracoscopic lobectomy performed in our hospital for 113 non-small cell lung cancer （NSCLC） cases from October 2010 to October 2013. hTe incision for observation was 1.5 cm the eighth intercostal at the rear of the midaxillary line and the incision for operation was 2.0 cm-4.0 cm at the fourth or iftfh intercostal of the anterior axillary line. hTe operations were performed through the single-operation-hole. Result hTe operation processes were smooth for all the patients without any operative mor-tality occurrence. Only in 5 cases was the operation hole expanded because of the occurrence of massive hemorrhage during the operation;3 patients with postoperative complications underwent thoracoscopic lobectomy again, including 2 cases of de-layed hemorrhage and 1 case of chylothorax. hTe average surgical duration was （178.24±31.17） min, the average blood loss was （213.56±62.38） mL, and the number of lymph nodes dissected was from 5-22. All diagnose were conifrmed by pathology atfer operation. hTe average length of stay was （8.17±2.93） d. All cases recovered well during the follow-up of （2-38） months, only 5 cases had recurrence or metastasis. Conclusion hTe single-operation-hole thomcoscopic lobectomy for lung cancer is safe and feasible, further reducing the trauma, and can be used as a conventional treatment for early-or medium-term NSCLC.