单孔胸腔镜手术治疗肺部疾病的应用价值研究

目的探讨单孔胸腔镜手术（uVATS）在肺部良恶性病变治疗中的应用价值。方法回顾分析2016年2月至2017年3月40例行单孔胸腔镜肺部手术患者的临床资料。结果所有患者均在单孔胸腔镜下完成手术，无中转开胸手术患者。其中肺楔形切除术26例（A组），肺癌根治术14例（B组）。A组手术时间43-150min，平均（86．58±31．10）min；术中失血量5-200ml，平均（43．27±46．45）ml；术后第l天引流量0-400ml，平均（83．65±91．91）ml；术后总引流量0-1050ml，平均（285．19±264．43）ml；拔管天数1-5d，平均（2．65±1．09）d；术后住院天数2-11d，平均（4．62±1．83）d。B组手术时间120-270min，平均（207±52．39）min；术中失血量5-400ml，平均（110．71±104．11）ml；清扫淋巴结数10-26个，平均（17．07±5．37）个；术后第1天引流量0-300ml，平均（145±100．9）ml；术后总引流量160-2815ml，平均（1046．43±856.81）ml；拔管天数3-10d，平均（5．29±2．81）d；术后住院天数4-14d，平均（7．29±3.31）d。术后病理良性疾病9例，肺癌31例。由于患者高龄，肺功能较差不能耐受肺叶切除术或为晚期转移瘤，部分肺癌患者仅行肺楔形切除术。有3例拔管后出现皮下气肿，1例给予胸腔穿刺治疗。3例术后出现漏气，拔管时间较长。无肺部感染、出血、肺栓塞等术后并发症。结论单孔胸腔镜治疗肺部疾病是一种安全可行的手术方式，值得学习推广。

Objective To evaluate the effects of uniportal video-assisted thoracoscopic surgery （ uVATS ） in the pulmonary diseases. Methods The clinical data of 40 patients with pulmonary diseases from February 2016 to March 2017 treated by uniportal video-assisted thoracoscopic surgery in the First Affiliated Hospital of Soochow University were retrospectively analyzed. Results All the operations were successfully completed, none of them was conversed to thoracotomy. There were 26 cases of wedge resection （ Group A ） , 14 cases of pulmonary lobeetomy （ Group B ） . In Group A, the operation time was 43-150min, （ 86.58 ±31.10 ） min in average. The blood loss was 5-200ml, （ 43.27 ± 46.45 ） ml in average. The first 24h drainage was 0-400ml, （ 83.65 ± 91.91 ） in average. Postoperative total drainage was 0-1050ml, （ 285.19 ±264.43 ） ml in average. Tube removed time was 1-5 days, （ 2.65 ＋ 1.09 ） in average. Postoperative hospital stay was 2-1.1 days, （ 4.62± 1.83 ） days in average. In Group B, the operation time was 120-270min, （ 207 ± 52.39 ） min in average. The blood loss was 5-400ml, （ 110.71 ±104.11 ） ml in average. The amount of lymph node was 10-26, （ 17.07 ± 5.37 ） in average. The first 24h drainage was 0-300ml, （ 145 ± 100.90 ） in average. Postoperative total drainage was 160-2815ml, （ 1046.43 ± 856.81 ） ml in average. Tube removed time was 3-10 days, （ 5.29 ± 2.81 ） in average. Postoperative hospital stay was 4-14 days, （ 7.29 ± 3.31 ） days in average. There were 9 cases of benign lung tumor, 31 cases of lung cancer. Wedge resection of lung cancer was applied due to poor lung fimction in elderly patients, inadequate tolerance against lobectomy or metastatic tumor. Three patients had subcutaneous emphysema after removing the tube. One of them was given pleurocentesis. Three patients had pulmonary air leakage, which had a longer tube removed time. None of them had pulmonary infection, bleeding, pulmonary embolism and other complications. Conclusion The uniportal VATS is a safe and feasible way to treat the pulmonary diseases. It is worthy of clinical promotion.