单操作孔胸腔镜下支气管袖式切除肺癌根治术5例报告

Single Utility Port Thoracoscopic Bronchial Sleeve Lobectomy: a Report of 5 Cases

目的探讨单操作孔胸腔镜下支气管袖式切除、淋巴结清扫治疗中央型肺癌的疗效和价值。方法 2013年11月~2015年8月行单操作孔胸腔镜下支气管袖式肺叶根治性切除5例,腋前线与腋中线之间第7肋间长1.5 cm切口作为观察孔,腋前线第4肋间长约4 cm切口作为操作孔,完成肺叶切除、淋巴结清扫和支气管吻合,术后常规放置1或2根胸腔引流管。结果 5例顺利完成单操作孔胸腔镜下支气管袖式肺叶切除和淋巴结清扫。术中常规支气管切缘快速病理为阴性。手术时间分别为310、260、220、200、280 min;术中出血量分别为100、120、90、110、160 ml;术后总引流量分别为600、1260、440、560、800 ml;术后带管时间分别为5、7、4、4、5 d;术后住院分别9、12、7、8、10 d。切口疼痛轻微。术后发生肺炎、肺不张各1例,无支气管胸膜漏、脓胸、切口感染。5例术后随访3~19个月,均存活,无复发和转移。结论单操作孔胸腔镜下支气管袖式切除肺癌根治术安全可行,创伤小,可作为部分肺癌患者的推荐手术方式。

Objective To explore the clinical efficacy and value of single utility port thoracoscopic bronchial sleeve lobectomy and lymph node dissection for the treatment of central lung cancer. Methods Five cases of lung cancer underwent single utility port thoracoscopic bronchial sleeve lobectomy from November 2013 to August 2015. A 1. 5-cm incision was made as the observation port at the seventh intercostal space between the media axillary line and the posterior axillary line,and another 4-cm incision was made at the fourth intercostal space on the media axillary line as the utility port. The lobectomy and lymph node dissection and bronchial anastomosis were accomplished. One or two chest drainage tubes were placed. Results The single utility port thoracoscopic bronchial sleeve lobectomy and lymph node dissection were successfully completed in all the 5 patients. The intraoperative rapid pathological examinations found normal bronchial cutting edge without residual cancer. The operation time was 310,260,220,200,and 280 min,respectively. The blood loss was 100,120,90,110,and 160 ml,respectively. The total postoperative drainage volume was 600,1260,440,560,and 800 ml,respectively. The intubation time was 5,7,4,4,and 5 d,respectively. The postoperative hospital stay was 9,12,7,8,and 10 d,respectively. Patients experienced slight incision pain. Postoperative complications included1 case of pneumonia and 1 case of atelectasis. No bronchial pleural fistula,empyema,or wound infection occurred. The patients were followed up for 3- 19 months. No recurrence or metastasis was seen. Conclusions Single utility port thoracoscopic bronchial sleeve lobectomy and lymph node dissection for the treatment of central lung cancer is feasible,safe,and minimally invasive. It can be recommended for part of lung cancer patients.