控制性降压在单孔胸腔镜下淋巴结清扫中的应用

Application of Controlled Hypotension in 3 cm Single-port Video-assisted Thoracoscopic Surgery for Lymphadenectomy in Lung Resection

目的 探讨控制性降压在3cm单孔胸腔镜下左侧肺癌根治术第7组淋巴结清扫中应用的可行性及临床效果。方法 回顾性分析2015年5-8月华中科技大学附属同济医院胸外科行3cm单孔胸腔镜下左侧肺癌根治术37例患者的临床资料。其中12例患者在术中行第7组淋巴结节清扫时采用硝酸甘油或硝普钠将收缩压控制在80-90 mm Hg左右,并与同期未行控制性降压的25例患者进行对比。试验组中,男7例、女5例,平均年龄58.3（42-69）岁。对照组中,男14例、女11例,平均年龄57.7（43-68）岁。两组患者既往无高血压及心脑血管病史。结果 控制性降压在第7组淋巴结节清扫时取得了满意的效果,清扫时间15.6-25.3（18.5±4.3）min,同期对照组清扫时间18.2-29.8（24.3±5.1）min,差异有统计学意义（P〈0.05）。结论 3cm单孔胸腔镜术中控制性降压有助于降低第7组淋巴结清扫难度,减少出血风险,不增加术后并发症,是简易可行的方法。

Objective To investigate the feasibility and clinical effect of controlled hypotension in 3 cm single-port video-assisted thoracoscopic surgery （VATS） for the lymph node group 7 dissection in the left lung resection. Methods We retrospectively analyzed the clinical data of 37 patients with lung cancer who underwent 3 cm single-port VATS from May 2015 to August 2015 in Tongji Hospital, and systolic blood pressure of 12 patients （7 males, 5 females, average age of 58.3 years, range 42-69 years） was controlled between 80-90 mm Hg by nitroglycerin or sodium nitroprusside while the pressure of 25 patients （14 males, 11 females, average age of 57.7 years, range 43-68 years） was not controlled when receiving lymph node group 7 dissection. Results Controlled hypotension in lymphadenectomy achieved satisfactory results. The lymphadenectomy time of 12 patients with controlled hypotension （18.5＋4.3 min on average, range 15.6-25.3 min） was shorter than that of 25 patients without controlled hypotension （24.3±5.1 min on average, range 18.2-29.8 min）; the difference was statistically significant （P〈0.05）. Conclusion Controlled hypotension is a simple and feasible method that increases the operating space, and reduces the difficulty of cleaning lymph nodes and the risk of bleeding.