3D胸腔镜系统在胸部微创手术中的初步应用

Application of three-dimensional thoracoscope system in minimally invasive thoracic surgery

背景与目的：随着3D技术的发展,医学腔镜微创外科手术已经进入3D时代。3D全高清腹腔镜手术较传统腹腔镜手术视觉效果更佳、安全性更高的优势已经得到广泛认可。该研究旨在探讨3D胸腔镜系统在胸部微创手术中的初步应用效果。方法：2014年3月—10月使用KARL STORZ 3D胸腔镜系统完成胸腔镜手术96例,包括3D胸腔镜肺叶切除术33例,肺段切除术2例,肺楔形切除术10例,纵隔肿瘤切除术27例,食管肿瘤切除术20例,贲门失弛缓症4例。统计手术时间、术中出血量、胸管引流时间、术后住院日及并发症等数据。结果：96例手术均获成功。手术时间为30~237 min,其中肺局部切除术为30~120 min,平均为52 min;肺叶切除术为63~122 min,平均为75 min;纵隔手术为35~125 min,平均为77 min;食管手术为57~237 min,平均为189 min。术中出血量肺部手术为2~85 m L,平均为50 m L;纵隔手术为15~72 m L,平均为47 m L;食管手术为30~186 m L,平均为118 m L。术后胸管引流时间肺部手术为1~5 d,纵隔手术为1~3 d,食管手术为2~6 d。术后住院日肺部手术为2~10 d,平均为6.3 d;纵隔手术为3~6 d,平均为4.2 d;食管手术为4~19 d,平均为13.3 d。所有患者术后随访3个月均未出现手术并发症或复发转移征象。结论：3D胸腔镜系统既保留了电视胸腔镜手术（video-assisted thoracoscopic surgery,VATS）的微创特点,又兼有高清立体视野下精细操作的优势,手术安全性增高;由于该系统恢复了类似开放手术的自然视觉优势,操作更容易,学习曲线更短。

Background and purpose： With the development of the three-dimensional （3D） science, minimally invasive technology is going into the 3D period. While 3D laparoscope system has been widely accepted by surgeons because of its better visual effect and safer operations compared to traditional laparoscope system, this study aimed to evaluate the feasibility of 3D thoracoscope system in minimally invasive surgery for the treatment of thoracic diseases. Methods： A total of 96 cases of thoracic diseases were accomplished with KARL STORZ 3D thoracoscope during Mar. 2014 to Oct. 2014, including 33 cases of lobectomy, 2 cases of segmentectomy, and 10 cases of wedge resection of pulmonary tumor, 27 cases of mediastinal tumor, 20 cases of esophageal tumor and 4 case of esophageal achalasia. The data of operative time, bleeding volume, postoperative chest tube drainage and hospital time and postoperative complications were counted. Results： All the operations were completed successfully, without conversion to open surgery. All the operations cost 30 to 237 min. The operation of local resection lasted 30 to 120 min, with an average of 52 rain, the operation of pulmonary lobectomy lasted 63 to 122 min, with an average of 75 min, the operation of mediastinal tumor resection lasted 35 to 125 min, with an average of 77 min; and the operation of esophageal diseases lasted 57 to 237 rain, with an average of 189 min. The bleeding volumes were 2 to 85 mL, 15 to 72 mL, 30 to 186 mL and with the average of 50 mL, 47 mL, 118 mL in pulmonary, mediastinal and esophageal operations respectively. The time of postoperative chest tube drainage of each surgery was 1 to 5 days after pulmonary operations, 1 to 3 days after mediastinal operations, and 2 to 6 days after esophageal operations. The postoperative hospital time of pulmonary operation was 2 to 10 days, with an average of 6.3 days; the time of mediastinal operation was 3 to 6 days, with an average of 4.2 days; and the time of esophageal operation was 4 to 19 days, with an average of 13.3 days. No complications and tumor recurrence or metastasis were observed during the followed 3 months. Conclusion： 3D thoracoscope system not only preserves the minimally invasive advantage of video-assisted thoracoscopic surgery （VATS）, it can also provide high-definition and stereoscopic vision and better sense of depth which facilitate the operation more precise and safer, thus operation time becomes shorter. Besides, 3D system possesses the advantage of natural vision similar to open surgery, thus it has an easier and shorter learning curve.