半俯卧位单孔胸腔镜后路法右上肺叶切除术

Posterior approach for uniportal video-assisted thoracic surgery right upper lobectomy in the semiprone position

目的探索半俯卧位单孔胸腔镜后路法右上肺叶切除术的技术特点。方法 2014年12月至2017年12月,本小组连续97例单孔胸腔镜右上肺叶切除均采用半俯卧位后路法。男41例、女56例,年龄26～79(57.8±10.6)岁。肺门结构从后往前依次处理。肺癌患者加行纵隔淋巴结清扫。结果 97例患者中93例顺利完成半俯卧位单孔胸腔镜后路法右上肺叶切除术,3例改为前后路相结合的方法,1例中转开胸。平均手术时间76～192(127.0±32.0)min,平均出血量10～300(36.8±32.8)ml,术后平均胸腔引流管放置时间2～20(3.4±2.7)d。术后平均住院时间3～23(5.4±3.1)d。无围术期死亡,7例患者发生术后并发症。结论半俯卧位单孔胸腔镜后路单向式右上肺切除术安全可行,能够减少术者及助手的疲劳,减少肺的翻动,显露佳,使手术更加流畅。在复杂病例中,可使用前后路法相结合。

Objective To increase the advantage and decrease the disadvantage of posterior approach for uniportal video-assisted thoracic surgery (VATS)right upper lobectomy.Methods Data of 97consecutive patients who received uniportal VATS right upper lobectomy using posterior approach in the semiprone position were retrospectively analyzed from Dec,2014 to Dec,2017.There were 41 males and 56 females at age of 26-79(57.8±10.6) years.The hilar structure was cut from posterior to anterior one by one.The mediastinal lymph nodes were dissected if lung cancer was diagnosed.Results Ninety three of 97 patients were successfully completed with uniportal VATS right upper lobectomy using posterior approach,3 of them were completed with posterior approach combined with anterior approach,and 1of them needed thoracotomy.The mean operative time was 76-192(127.0±32.0)min.The thoracic drainage time was 2-20(3.4±2.7)d.The postoperative length of hospital stay was 3-23(5.4±3.1)d.There were postoperative complications in 7 patients and no postoperative mortality.Conclusion Posterior approach for uniportal video-assisted thoracic surgery right upper lobectomy is safe and feasible,which can decrease the fatigue of both the surgeon and the assistant.It also provides with better exposure of posterior'mediastinum,less dragging lung,and less interference of the instruments and help keep the clear surgical field.In complicated cases,posterior approach could combine with anterior approach to complete the VATS lobectomy.