钟表盘综合定位法单操作孔胸腔镜在高龄(≥70岁)肺肿瘤患者中的应用

Clinical Analysis of Single Utility Port Video-assisted Thoracoscopic Surgery With Clock Dial Integrated Positioning for Lung Neoplasms in Elderly Patients(≥70 Years Old)

目的探讨钟表盘综合定位法单操作孔全胸腔镜手术治疗高龄(≥70岁)肺肿瘤患者的安全性、可行性。方法回顾性分析2016年3~6月48例高龄患者(年龄≥70岁)行钟表盘综合定位法单操作孔全胸腔镜手术治疗的临床资料。全胸腔镜下完成病灶切除(肺叶切除、肺段切除、楔形切除)和肺门、纵隔淋巴结清扫或采样。结果 48例均于全胸腔镜下完成手术,包括肺叶切除8例,肺段切除19例,楔形切除21例,无二次开胸,无严重并发症,无围术期死亡。手术时间(54.5±25.5)min,术中出血量(83.8±72.9)ml。留置胸腔引流(4.5±2.2)d,术后住院时间(4.9±2.3)d,均顺利出院。恶性40例(腺癌29例,鳞癌8例,神经内分泌癌1例,大细胞癌1例,小细胞癌1例),第八版TNM分期ⅠA1期15例,ⅠA2期15例,ⅠA3期5例,ⅠB期2例,ⅡA期2例,ⅡB期1例;良性8例。48例随访(10.5±1.0)月,1例术后6个月肿瘤复发转移(肋骨转移),无死亡病例。结论钟表盘综合定位法单操作孔胸腔镜治疗高龄肺肿瘤患者定位准确,安全可行。

Objective To investigate the safety and feasibility of the clock dial integrated positioning in single utility port video-assisted thoracoscopic surgery（ SUPVATS） in elderly patients（ over 70 years old） with lung neoplasms. Methods We conducted a retrospective review of clinical data of 48 elderly cases receiving clock dial integrated positioning SUPVATS from March2016 to June 2016. The excision of the lesion,including lobectomy,segmentectomy or wedge resection,as well as hilar and mediastinal lymph node dissection or sampling,was carried out. Results All the patients were operated under the thoracoscopic surgery,including 8 cases of pulmonary lobectomy,19 cases of segmental resection and 21 cases of wedge resection. No secondary operation was required. No severe complications or mortality were observed during perioperative period. The operative time was（ 54. 5 ± 25. 5） min,and the intraoperative bleeding was（ 83. 8 ± 72. 9） ml. The chest tube drainage duration was（ 4. 5 ± 2. 2） days,and the postoperative hospital stay was（ 4. 9 ± 2. 3） days. All the patients were discharged smoothly after surgery. There were 40 cases of malignant tumor,including 29 cases of adenocarcinoma,8 cases of squamous cell carcinoma,1 case of neuroendocrine carcinoma,1 case of large cell carcinoma,and 1 case of small cell lung carcinoma. According to the 8 th edition of TNM stage,15 cases were stageⅠA1,15 cases were stage ⅠA2,5 cases were stage ⅠA3,2 cases were stage ⅠB,2 cases were stage ⅡA and 1 case were stage ⅡB. The other 8 cases were benign tumors. The mean postoperative follow-up time of all patients was（ 10. 5 ± 1. 0） months. One case developed rib metastasis at 6 months after surgery. No mortality was seen. Conclusion The method of clock dial integrated positioning in single utility port video-assisted thoracoscopic surgery is accurate,safe and feasible in elderly patients with lung neoplasms.