3D-CTBA及3D-VATS单操作孔行解剖性肺段切除治疗非小细胞肺癌

Combining 3D-CTBA and 3D-VATS Single-Operation-Hole to Anatomical Segmentectomy in the Treatment of Non-small Cell Lung Cancer

背景与目的中国是肺癌高发地区,其发病率及死亡率在恶性肿瘤中均占首位。目前低剂量CT检查的普及使早期肺癌检出率显著提高,解剖性肺段切除目前广泛应用于Ia期非小细胞肺癌(non-small cell lung cancer,NSCLC)及不能耐受肺叶切除肺癌患者。但因肺段解剖结构及手术操作相对复杂,使得其具有较高的手术风险与难度。我们应用三维计算机断层扫描支气管血管成像(three-dimensional computed tomography bronchography and angiography,3D-CTBA)及三维电视辅助胸部外科技术(three-dimensional video-assisted thoracic surgery,3D-VATS)单操作孔行解剖性肺段切除微创手术技术治疗NSCLC,以探讨其临床效果,为其临床应用提供相关可行性及理论依据。方法回顾性分析苏州大学附属第一人民医院胸外科2015年10月-2017年04月共施行57例术前对肺部病灶予以3D-CTBA重建以及术中应用3D-VATS单操作孔进行解剖性肺段切除治疗NSCLC病例。结果全组均全腔镜下顺利完成,无中转开胸。手术时间平均(142.2±28.3)min,术中出血量平均(93.8±46.5)m L。平均淋巴结清扫数目(9.1±2.2)个,术后胸腔引流量平均(429.8±181.2)m L。术后留置胸管时间(2.8±1.1)d。平均住院时间(5.2±1.3)d。术后病理示良性病变9例,约占15.7%,恶性病变48例,约占84.2%。术后并发症:肺部感染3例(5.2%),肺不张1例(1.7%),少量咯血1例(1.7%),肺漏气2例(>3 d,3.5%),心律失常4例(7.0%)。术后平均随访10个月,无支气管胸膜瘘、乳糜胸、包裹性胸腔积液等并发症,随访患者中无复发及远处转移病例。结论应用3D-CTBA及3D-VATS单操作孔行解剖性肺段切除治疗NSCLC的安全有效,适用于早期NSCLC以及不能耐受肺叶切除患者。

Background and objective China is a high-incidence area of lung cancer, and its morbidity and mortality were the highest in malignant tumors. At present, the popularization of low-dose computed tomography（CT） examination has significantly improved the detection rate of early lung cancer, anatomical segmentectomy is currently widely used early in non-small cell lung cancer（NSCLC） and those who cannot tolerate lobectomy in patients with lung cancer. However, the anatomical structure of segment and its surgical operation is relatively complex, lead to segmentectomy has a high risk and difficulty. We performed anatomical segmentectomy by use of combining three-dimensional computed tomography bronchography and angiography（3D-CTBA） and three-dimensional video-assisted thoracic surgery（3D-VATS） single-operationhole minimally invasive surgery in the treatment of NSCLC to investigate its clinical effect, and evaluate its clinical relevant feasibility and theoretical basis. Methods We carried out a retrospective review of the 57 cases by use of combining 3D-CTA in preoperative and 3D-VATS single-operation-hole anatomical segmentectomy in intraoperative in the treatment of NSCLC performed in Department of Thoracic Surgery, the First Affiliated Hospital of Soochow University from October 2015 to April2017. Results The whole group was successfully performed by use of VATS without anyone conversion to thoracotomy. The mean operation time was（142.2±28.3） min, and the mean blood loss was（93.8±46.5） m L. The mean number of lymph node dissection was（9.1±2.2）, and the mean postoperative thoracic drainage was（429.8±181.2） m L. The postoperative retention of chest tube time was（2.8±1.1） d. The mean hospitalization time was（5.2±1.3） d. The postoperative pathology showed 9 cases with benign lesions, accounting for 15.7%, 48 cases with malignant lesions, accounting for 84.2%. Postoperative complications： pulmonary infection in 3 cases（5.2%）, atelectasis in 1 case（1.9%）, small amount of hemoptysis in 1 case（1.9%）, lung leakage 3 d in 2 cases（3.5%）. Arrhythmia in 4 cases（7.0%）. The patients were followed up for 10 months. No complications occurred such as bronchial pleural fistula, chylothorax, encapsulated pleural effusion and those patients were followed up without recurrence and distant metastasis. Conclusion The use of combining 3D-CTBA and 3D-VATS single-operation-hole to anatomical segmentectomy is safe and effective in the treatment of NSCLC and is suitable for early non-small cell lung cancer, especially those can not tolerate lobectomy.