胸腔镜下双肺多发结节同期手术治疗

Single-stage bilateral pulmonary resections by video-assisted thoracic surgery for multiple small nodules

目的总结胸腔镜下双肺多发结节同期手术治疗要点。方法回顾性分析2015年1月至2016年12月上海市新华医院心胸外科24例双肺结节患者同期进行了单操作孔胸腔镜下肺叶/亚肺叶切除手术患者的临床资料。男9例、女15例,年龄33~69(55.0±8.0)岁。其中2例行肺叶-肺叶切除,9例行肺叶-亚肺叶切除,13例行亚肺叶-亚肺叶切除。结果所有手术完成顺利,手术时间135~330(231.4±59.1)min,术后胸腔引流时间2~17(5.4±3.1)d,术后住院时间5~37(8.6±6.3)d,住院期间无死亡病例,17例(70.8%)患者恢复顺利,术后并发症包括切口感染1例,肺部感染1例,肺持续性漏气>3 d 3例,单侧胸腔积液持续>200 ml/d 2例。结论经过选择的双肺结节患者同期行胸腔镜下双肺手术可行性好,治疗效果满意。

Objective To share the experience of single-stage bilateral pulmonary resections by video-assisted thoracic surgery（VATS） for multiple nodules. Methods Clinical records of patients undergoing one-stage bilateral resections of multiple pulmonary nodules between January 2015 and December 2016 in our institution were retrospectively reviewed and analyzed. There were 9 males and 15 females, aged from 33 to 69（55.0±8.0） years. Two patients underwent bilateral lobectomy. Lobar-sublobar（L/SL） resection and bilateral sublobar resection（SL-SL） were conducted in 9 patients and 13 patients respectively. Results All operations completed successfully. Operation time was135–330（231.4±59.1） min, duration of use of chest drains was 2–17（5.4±3.1） days. Overall duration of hospitalization after surgery was 5–37（8.6±6.3） days. There was no perioperative death. Postoperative course was uneventful in 17（70.8%） patients. The postoperative complications included one patient of incision infection and one patient of pulmonary infection. Persistent air leak for 〉3 days duration and unilateral pleural drainage for more than 200 ml/d were observed in3 patients and 2 patients respectively. Conclusion Single-stage bilateral surgery in selected patients with synchronous bilateral multiple nodules is feasible and associated with satisfactory outcomes.