全胸腔镜解剖性肺段切除术30例

Total Thoracoscopic Anatomic Pulmonary Segmentectomy in 30 Patients

目的探讨全胸腔镜解剖性肺段切除术治疗早期肺癌、肺转移瘤和肺良性疾病的可行性。方法 2011年1月～2016年1月我院行VATS肺段切除术30例,采用全胸腔镜三切口,用推结器丝线结扎或钛夹夹闭肺段动、静脉,切割缝合器闭合切断支气管,恶性肿瘤最后系统清扫区域淋巴结。结果 30例成功施行全胸腔镜解剖性肺段切除术,无中转开胸,其中切除左上肺舌段8例、尖前段1例、左下肺背段9例、基底段2例、右下肺基底段1例、背段9例,无围术期死亡。术后病理：ⅠA期肺癌20例,肺转移瘤2例,肺良性疾病8例（其中肺结核4例,支气管扩张2例,炎性假瘤2例）。ⅠA期肺癌手术时间（151.2±31.3）min,术中出血量（139.5±102.4）ml,术后拔胸管时间（4.6±1.3）d,术后住院时间（5.3±1.4）d。肺良性疾病手术时间（143.2±38.3）min,术中出血量（132.5±102.6）ml,术后拔胸管时间（4.1±1.4）d,术后住院时间（5.2±1.3）d。1例结肠癌肺转移手术时间150 min,术中出血量136 ml,术后拔胸管时间5 d,术后住院时间6 d。1例直肠癌肺转移手术时间141 min,术中出血量128 ml,术后拔胸管时间4 d,术后住院时间5 d。30例术后随访3～12个月,平均7.1月,均无复发及死亡。结论 VATS解剖性肺段切除术安全可靠,在最大限度保留肺功能的前提下应用于ⅠA期肺癌、不易行肺楔形切除术的肺转移瘤和肺良性疾病患者,尤其适用于老年低肺功能患者,适合临床推广应用。

Objective To investigate the feasibility of total thoracoscopic atatomic pulmonary segmentectomy for the treatment of early-stage lung cancer,pulmonary metastasis and benign lung diseases. Methods There were 30 cases of total thoracoscopic atatomic pulmonary segmentectomy in our hospital from January 2011 to January 2016. The surgery was performed by using three totally thoracoscopic incisions. Segmental artery and vein were managed with node pushing silk ligature or titanium clipping. The bronchus was cut and closed with the cutter stapler. The malignant tumor in the end system was managed with cleaning regional lymph nodes.Results Thirty patients successfully underwent total thoracoscopic atatomic pulmonary segmentectomy,including 8 cases of left upper lobe lingular segment and 1 case of apical and anterior segment,9 cases of left lower lobe dorsal segment and 2 cases of basal segment,1 case of right lower lobe basal segment and 9 cases of dorsal segment. There was no conversion to thoracotomy or perioperative mortality. Postoperative pathological examinations showed 20 cases of stage ⅠA lung cancer,2 cases of lung metastases,and 8 cases of benign diseases（ including 4 cases of pulmonary tuberculosis,2 cases of bronchiectasis,and 2 cases of inflammatory pseudotumor）.For stage ⅠA lung cancer,the operation time was（ 151. 2 ± 31. 3） min,the amount of bleeding during the operation was（ 139. 5 ±102. 4） ml,the postoperative time of chest tube drainage was（ 4. 6 ± 1. 3） d,and the time of postoperative hospital stay was（ 5. 3 ±1. 4） d. For benign lung diseases,the operation time was（ 143. 2 ± 38. 3） min,the amount of bleeding during the operation was（ 132. 5 ± 102. 6） ml,the postoperative time of chest tube drainage was（ 4. 1 ± 1. 4） d,and the time of postoperative hospital stay was（ 5. 2 ± 1. 3） d. For 1 case of plumonary metastasis of colon carcinoma,the operation time was 150 min,the amount of bleeding during the operation was 136 ml,the postoperative time of chest tube drainage was 5 d,and the time of postoperative hospital stay was 6 d.For 1 case of plumonary metastasis of rectal carcinoma,the operation time was 141 min,the amount of bleeding during the operation was 128 ml,the postoperative time of chest tube drainage was 4 d,and the time of postoperative hospital stay was 5 d. All the patients were followed up for 3- 12 months（ mean,7. 1 months）. No recurrence or death occurred. Conclusions Total thoracoscopic atatomic pulmonary segmentectomy is safe and reliable. With the maximum retention of pulmonary functions,it can be applied to stageⅠA lung cancer,and lung metastatic tumors and benign diseases inapplicable to pulmonary wedge resection operation,especially suitable for the elderly patients with low pulmonary functions. It is suitable for clinical application.