单操作孔胸腔镜肺叶切除术初步经验:附连续71例病例报告

An initial experience of a single utility thoracoscopic lobectomy with 71 consecutive patients

目的 总结单操作孔全胸腔镜肺叶切除术（VATS）的初步经验。方法 2009年12月至2015年5月间江苏省肿瘤医院共进行单操作孔全胸腔镜下肺叶（肺段）切除术71例[其中男性33例,女性38例;年龄38~72岁,平均（55.5±6.9）岁],其中1例左上肺叶袖状切除术,2例肺段切除术。结果 单操作胸腔镜肺叶切除术手术时间108~320 min,平均（162.9±56.8）min;操作孔长度2.5~6.0 cm,平均（3.2±0.8）cm;每例患者淋巴结清扫枚数目8~21枚,平均（13.4±4.6）枚;其中2例术中出血,中转开胸,其余均手术顺利。胸腔闭式引流时间术后3~19 d,平均（3.8±3.1）d;住院时间7~35 d,平均（9.8±5.6）d;无围手术期死亡及重大并发症发生。结论 单操作孔VATS肺叶切除术安全、可靠,是创伤更小的胸腔镜下手术方式,具有很好的临床推广前景。

Objectives This study summed up an initial experience of a single utility video-assisted thoracoscopic surgery （VATS） lobectomy. Methods A total of 71[ male 33, female 38; mean age （55.5 ± 6.9 ）years old, range 38-721, who underwent major pulmonary resection （segmentectomy, lobectomy, sleeve lobectomy） through a consecutive VATS using a single utility from Dec. 2009 to May 2015, were included in this study. Lobectomy was performed in most patients （ n = 38 ）, and sleeve lobectomy was performed in 1 patient, and segmentectomy in 2 patients. Results The mean time of the operation, in 71 patients who were completed by two-incisions VATS lobectomy, was [ （ 162. 9 ± 56.8） minutes （ range, 108-320） minutes ]. The utility incision length was [ （ 3.2 ± 0.8 ） cm （ range, 2.5-6.0）cm]. The total number of dissected lymph nodes per patient was [ （13. 4 ± 4. 6）range, 8-21 range]. Conversion to thoracotomy was performed in 2 patients （2.8%） due to bleeding at pulmonary arterial branch. The chest tube was removed on postoperative day [ （3.8 ± 3.1 ）range, 3-19 range], and the mean time of hospitalization was [ （9.8 ± 5.6） days, range 7-35 days ]. There was no occurrence of major perioperative morbidity and mortality. Conclusion In the hands of experienced VATS surgeons,it is safe and feasible to perform VATS lobectomy with a single utility.