单操作孔全胸腔镜在34例肺癌完全切除术中的应用

The clinical application of complete single utility port VATS in complete resection of lung cancer: an analysis of 34 cases

目的探讨单操作孔全胸腔镜手术在肺癌完全切除术中运用的可行性及安全性。方法回顾性分析2014年9月-2014年11月间34例行单操作孔全胸腔镜下肺癌完全切除术的临床资料。胸腔镜观察孔取腋中线后侧第8肋间,切口约1-2cm,根据肿瘤定位操作孔位置于第3至5肋间取腋前线至腋中线间,切口长约2cm-4cm,经单一操作孔完成肺癌完全切除术,其中19例术前已有病理学诊断,直接行肺叶切除淋巴结清扫,13例术中先行肿块切除,冰冻为恶性,再行肺叶切除淋巴结清扫。结果全组患者手术顺利,无围手术期死亡病例,其中1例患者因术中出血转常规开胸;33例行单肺叶切除加淋巴结清扫其中:左肺上叶5例,左肺下叶11例,右肺上叶6例,右肺中叶2例,右肺下叶9例,1例行右肺中下叶双肺叶切除。全组手术平均手术时间(169.1±54.2)min;平均术中失血(255.2±94.7)ml;术中清扫淋巴结5-17枚;胸腔引流管拔出时间平均(2.1±1.2)d;术后胸腔引流总量平均(258.8±193.7)ml;术后第一次下床活动时间平均(13.1±9.1)h;术后平均住院时间平均(7.8±3.93)d;术后发生并发症主要有:肺不张2例、心律失常3例、肺部感染1例,乳糜胸1例;术后患者均顺利恢复。结论单操作孔全胸腔镜肺癌完全切除术安全可行,可以作为早中期肺癌常用的手术方式。

Objective To explore the feasibility and safety of single utility port complete VATS in the treatment of lung cancer. Methods Retrospective analysis of 34 lung cancer patients underwent the single utility port thoracoscopic lobotomy from Sep 2014 to Nov 2014. The incision for observation was 1cm-2cm in the eighth intercostal at the rear of the midaxillary line and the incision for operation was 2.0cm-4.0cm at the third or fifth intercostal of the anterior axillary line oriental by the tumor location observed. The operations were performed by single utility port complete VATS. 19 cases with preoperative for pathological diagnosis underwent direct lobectomy and lymphadenectomy, 13 cases underwent lump resecting frist, then received lobectomy and lymphadenectomy when diagnosis as malignant by frozen pathology section. Results The operation processes were smooth for all the patients without any operative-related mortality. 1 case had been transited to thoracotomy due to hemorrhage during the operation;33 cases underwent lobotomy（including： 5 left upper, 11 left lower and 6 right upper, 2 right middle, 9 right lower）;and 1 case underwent right middle and lower bilolectomy. The average surgical duration were（169.1±54.2）min, the average blood loss were（255.2±94.7） ml, the number of lymph nodes dissected was from 5-17, average chest drainage duration（2.1±1.2） d, postoperative total drainage volume（258.8±193.7） ml, time to first activity out of bed（13.1 ±9.1）h,and the average postoperative hospital stay were（7.8 ±3.93） d. The postoperative complications were ： pulmonary atelectasis 4cases, arrhythmia 3cases, pulmonary infection 3cases and chylothorax1 case.All cases recovered well. Conclusion The completely single utility port thoracoscopic lobectomy for early stage non small cell lung cancer is a safe and feasible surgical operation.