单操作孔电视胸腔镜解剖性肺段切除术47例报告

Single Utility Port Video-assisted Thoracoscopic Anatomic Pulmonary Segmentectomy:Analysis of 47 Cases

目的探讨单操作孔电视胸腔镜解剖性肺段切除术的安全性和可行性。方法 2013年6月～2014年12月我科施行单操作孔电视胸腔镜解剖性肺段切除术47例,术中观察孔位于腋中线第8或第9肋间,长1.5 cm,操作孔位于腋前线第4或第5肋间,长2～3 cm。术后常规放置1～2根胸腔引流管。结果 2例分别因支气管残端漏气和静脉回流不畅而转肺叶切除,余45例顺利完成解剖性肺段切除。术后病理：良性病变10例,原发性肺癌35例,转移癌2例。手术时间（164.5±33.7）min,术中出血（125.6±46.4）ml,术后胸管引流（4.2±1.2）d,术后住院（5.6±1.6）d。所有患者均痊愈出院,术后无严重并发症发生。31例随访1～18个月,（7.9±1.6）月,未见复发和转移,无手术相关死亡。结论单操作孔电视胸腔镜解剖性肺段切除术安全可行,可作为部分不能楔形切除的良性病变患者、术前无法明确性质又不能楔形切除的肿瘤患者和肺功能较差、不能耐受肺叶切除或预计肺叶切除后易发生并发症的早期肺癌患者的选择。

Objective To study the safety and feasibility of single utility port video-assisted thoracoscopic anatomic pulmonary segmentectomy. Methods From June 2013 to December 2014,47 patients underwent single utility port video-assisted thoracoscopic anatomic pulmonary segmentectomy in our hospital. The port for observation was about 1. 5 cm in length and located at the 8th or 9th rib on the middle axillary line,and the port for operation was about 2- 3 cm in length and located at the 4th or 5th rib on the anterior axillary line. Normally,one or two chest tubes were placed. Results Among these cases,conversion to lobectomy was required in 2cases due to accidental bronch-stump leakage and venous return dysfunction,while the operation was performed successfully in the other 45 cases. Postoperative pathological examinations showed benign lesions in 10 cases and malignant in 37（ 35 cases of primary lung cancer and 2 cases of metastatic tumor）. The operation time was（ 164. 5 ± 33. 7） min,the intraoperative blood loss was（ 125. 6 ± 46. 4） ml,the thoracic drainage time was（ 4. 2 ± 1. 2） d,and the postoperative hospital stay was（ 5. 6 ± 1. 6） d. All the 47 patients healed without severe complications. Follow-up reviews were conducted in 31 cases for 1- 18 months（ average,7. 9 ± 1. 6months）. No metastasis or tumor recurrence occurred. No death related to the operation occurred. Conclusions Single utility port video-assisted thoracoscopic anatomic pulmonary segmentectomy is safe and feasible. It can be utilized as an option for following patients with： benign lesions or unclear-nature tumors beyond wedge resection; early stage cancers with pool lung functions which is unable to tolerate pulmonary lobectomy or increased incidence of complications after radical surgery.