单孔胸腔镜在肺部疾病中的临床应用

Clinical application of uniportal video-assisted thoracoscopic surgery in pulmonary diseases

目的探讨单孔胸腔镜手术在治疗肺部疾病中的可行性及安全性。方法选择采用单孔胸腔镜手术治疗肺部疾病69例病人,病种包括肺癌、自发性气胸、肺隔离症、支气管扩张等8种疾病。行肺叶切除29例,肺局部切除40例。结果肺叶切除平均手术时间(170±32)min,术中平均出血量(205±145)m L,术后平均留置胸管时间(3.7±2.1)d,术后平均住院时间(8.3±3.1)d,术中1例被迫中转开胸,术后8例合并胸腔积液需再次处理。局部切除平均手术时间(64±32)min,术中平均出血量(68±23)m L,术后平均留置胸管时间(3.0±1.9)d,术后平均住院时间(5.7±1.8)d,术后1例出现持续性漏气,经保守治疗后痊愈。全组无其他并发症及围手术期死亡,随访3~12月均恢复良好,气胸病人无复发。结论单孔胸腔镜在治疗肺部疾病中安全可行,是一种更加微创的手术方式,近期效果满意,值得在临床上推广。

Objective To explore the feasibility and safety of uniportal video-assisted thoracoscopic surgery （VATS） in the treatment of lung diseases. Methods 69 patients with pulmonary diseases were underwent uniportal VATS,29 cases of lobectomy and 40 cases of partial lung resection,including 8 kinds of diseases,such as lung cancer,pulmonary sequestration,bronchiectasis and so on. Results The average operation time of lobectomy was （170±32） min,the average intraoperative blood loss was （205±145） mL,the average postoperative thoracic drainage time was （3.7±2.1）days,the average postoperative hospital stay was （8.3±3.1） days.Only one case converted to open approach while 8 patients needed to be treated again with pleural effusion.The mean time of partial lung resection surgery was （64±32）min,the mean intraoperative bleeding was （68±23） mL,the mean thoracic drainage time was （3.0±1.9）days,and the mean postoperative hospital stay was（5.7±1.8）days.One case of persistent postoperative leakage recovered after conservative treatment.There were no other complications and death occurred.Followed up for 3-12 months,all patients recovered well and no recurrence of pneumothorax. Conclusion The uniportal video-assisted thoracoscopic surgery in pulmonary resection is safe and feasible.It is a new minimally invasive surgical approach with satisfactory short-term outcome,and it is worth to be applied in pulmonary diseases.