单操作孔全胸腔镜肺叶切除术治疗肺癌63例临床应用体会

Experience of Single-port thoracoscopic lobotomy in 6 3-cases of lung cancers

【目的】探讨单操作孔全胸腔镜肺叶切除术的临床应用体会。【方法】2013年10月至2014年11月本院共施行63例肺癌单操作孔全胸腔镜下肺叶切除术。术中取第8肋间腋中线切口约1.5 cm 作为胸腔镜观察孔,腋前线第4或5肋间4～5 cm 切口作为单操作孔。所有手术均通过单操作孔完成肺叶切除术,同时行系统淋巴结清扫。【结果】全组手术时间78～169（102±27）min,术中出血90～280（165±30）mL ,术中淋巴结清扫数为3～29（11.8±3.7）枚,术后胸管引流量300～1120（550±120）mL ,术后住院时间5～12（7.5±2.3）d 。所有患者均康复出院,未发生严重并发症及围术期死亡。【结论】在具备丰富的普胸手术基础,镜下操作积累一定经验,术前筛选把握适应证,术中细致谨慎操作的前提下,单操作孔全胸腔镜肺叶切除术治疗肺癌安全可靠,且具有创伤小,出血少,恢复快的优势。

[Objective]To study the clinical application of single-port thoracoscopic lobetomy on lung canc-ers.[Methods]A total of 63 lung cancers undergone single port thoracoscopic lobectomy in our department were selected from October 2013 to November 2014.An approximate 1.5 cm surgery incision as the thoraco-scope camera window was made at the 8th intercostal across the mid-axillary line,while an approximate 4 ～5cm incision as the primary working window was made at the 4th or 5th intercostal across the anterior axillary line.All cases underwent single-port thoracoscopic lobectomy with systematic （mediastinal ）lymph node dis-section.[Results]The average operative time was 102 ± 27 min（78 ～ 1 69 min）,the amount of intraoperative bleeding was 1 65±30 ml （90～280 mL）,the number of lymph node dissection was 1 1.8 ± 3.7 （3～29）,the amount of post-operative thoracic tube drainage was 550±120 ml （300～1 120 mL）,and the hospital stay was 7.5±2.3 d （5 ～12 d）.All patients recovered smoothly and there were no serious perioperative complications and no death occurred.[Conclusion]With basic skills of general thoracic surgercal techniques,experience of thoracoscope,preoperative selection of cases with appropriate indications,and carefully intraoperative per-formance,single-port thoracoscopic lobectomy is a safer,minimally invasive,lower hemorrhage,and quicker recovery method for lung cancers.