单操作孔电视胸腔镜肺癌根治术93例报告

Uniportal Video-assisted Thoracoscopic Surgery for Radical Resection of Lung Cancer: a Report of 93 Cases

目的探讨单操作孔电视胸腔镜手术（uniportal video-assisted thoracoscopic surgery，UVTAS）肺癌根治术的安全、可行性。方法2011年8月一。2013年7月行UVATS治疗93例肺癌，胸腔镜观察孔取腋后线第8或第9肋间，约1．5cm，操作孔取腋前线与锁骨中线之间第4或第5或第6肋间，切口长3—5cm，术后常规放置1或2根胸腔引流管。结果92例顺利完成手术，1例因肺动脉分支大出血中转开胸。手术时间（129．6±32．9）min，术中出血量（135．3±110．5）ml，术中淋巴结清扫（12．5±1．3）枚。术后3例发生并发症：2例肺不张，其中1例使用持续负压吸引和呼吸训练器1周后肺复张，1例通过加强咳嗽咳痰和持续负压吸引5d后肺复张；1例持续漏气时间超过7d，未特殊处理，术后第10天停止漏气。86例随访1～24个月，（11．6±1．5）月，无复发和转移，1例术后14个月死于脑血管疾病，其余85例无复发、转移。结论UVTAS能顺利完成肺癌根治术，安全、可行。

Objective To discuss the feasibility and safety of uniportal video-assisted thoracoscopic surgery （UVATS） in the treatment of lung cancer. Methods The clinical data of 93 patients with lung cancer who underwent uniportal UVATS from August 2011 to July 2013 were analyzed. The port for operation （length, 3 -5 cm） was located at the fourth or fifth or sixth rib at the anterior axillary line, while the port for observation （ length, 1.5 cm ） was located at the eighth or ninth rib at the posterior axillary line. Postoperatively, 1 or 2 chest tubes were placed. Results UVATS was successfully performed in 92 patients, while a conversion to open thoracotomy was made in 1 patient because of fatal bleeding from one branch of the pulmonary artery. The operation time was （ 129.6 ± 32.9） min, the intraoperative blood loss was （ 135.3 ± 110.5） ml, and the number of dissected lymph nodes was 12.5 ± 1.3. Postoperative complications occurred in 3 cases： 2 cases of atelectasis （The lung recruitment was obtained after 1 week of combining with breath training device utilization in 1 case, and after 5 days of breath training by coughing with continuous negative pressure suction in another case） and 1 case of persistent air leakage for more than 7 days （The leakage disappeared on the tenth day after operation）. All the patients were discharged without severe complications. A total of 86 patients were followed up for 1 -24 months, with an average of （ 11.6 ± 1.5） months, with no metastatic carcinoma or recurrence observed. One patient died from a cerebral hemorrhage 14 months after operation. Conclusion UVATS is a safe and feasible method in the treatment of lung cancer.