铥激光在胸腔镜下肺结节切除手术中的应用

Clinical application of thulium laser in thoracoscopic resection of pulmonary nodules

目的 探讨2μm铥激光在胸腔镜下肺结节切除中的应用价值.方法 回顾性分析首都医科大学宣武医院胸外科自2016年1～12月同期接受胸腔镜下肺结节切除术的61例患者资料,其中应用铥激光行肺部结节切除术组30例;一次性切割缝合器组31例.两组患者性别、平均年龄、吸烟比例基本均衡;病灶大小缝合器组略大于激光组.手术均在电视胸腔镜下完成,术中漏气分级评价激光组≤2级者28例,需要补救处理3级2例;缝合器组≤2级者30例,需要补救处理3级1例.结果 61例患者手术过程顺利.激光组与缝合器组比较,术后住院时间、总住院天数、差异均无统计学意义,引流管放置时间（2.71天）明显少于缝合器组（3.55天）.住院费用激光组少于缝合器组.结论 胸腔镜下肺结节切除手术应用2 μm铥激光微创、精准、安全.

Objective The aim of the present study was to evaluate the clinical application of 2 μm thulium laser in pulmonary nodules resection under VATS.Methods 61 patients,undergoing thoracoscopic resection of pulmonary nodules in thoracic department of Xuanwu Hospital,were identified between January and December of 2016.Of those,30 underwent 2μm thulium laser dissection and 31 were treated with standard technique by using staplers.In terms of clinical characteristics,including gender,age and smoking history,there is no significant difference between the laser group and the stapler group,but the lesion size was slightly larger in the stapler group compared with the laser group.The lesions of the two groups were almost evenly distributed on the five lobes.Results All the procedures were performed successfully under VATS.The intraoperative evaluation of air leaks demonstrated that less than or equal to 2 grade air leaks were observed in 28 cases in the laser group and in 30 cases in the stapler group.Grade 3 air leaks requiring a rescue treatment were observed in 2 cases in the laser group and in 1 case in the stapler group.There were no significant differences in the postoperative hospital stay and total hospital stay between two groups.Chest tube duration was lower in the laser group compared with the stapler group even if it was not statistically significant （2.71 vs 3.55 days）.Hospitalization costs was significantly lower for the laser group.Conclusion The use of 2um thulium laser to prevent intra-and postoperative air leaks and bleeding is effective and makes patients recover quickly,which allows a minimally invasive,accurate and safe application during thoracoscopic resection of pulmonary nodules.