全胸腔镜解剖性肺段切除术治疗结核性支气管扩张症

Treatment of Tuberculous Bronchiectasis With Anatomical Pulmonary Segmentectomy Under Video-assisted Thoracoscopic Surgery

目的探讨全胸腔镜解剖性肺段切除治疗结核性支气管扩张症的可行性。方法我院2014年1月~2018年2月采用全胸腔镜下解剖性肺段切除治疗结核性支气管扩张症46例。采用单操作孔,操作孔位于腋前线第4或5肋间,应用切口保护器,不使用肋骨牵开器,观察孔取腋中线第7或腋后线第8肋间,在全胸腔镜下完成解剖性肺段切除。结果无中转开胸,1例中转行肺叶切除,其余45例在全胸腔镜下完成解剖性肺段切除,其中右肺上叶间后段14例,右肺下叶背段6例,右肺下叶基底段2例,左肺上叶固有段15例,左肺上叶舌段2例,左肺下叶背段5例,左肺下叶基底段1例。手术时间100~330 min(中位数135 min);术中出血量100~650 ml(中位数230 ml);术后引流液总量380~2250 ml(中位数550 ml);术后带管时间4~16 d(中位数5 d);术后住院时间6~18 d(中位数9 d)。围手术期无死亡。术后并发症5例:漏气3例,肺膨胀不全1例,少量咯血1例。46例随访1~36个月(中位数21个月),86.9%(40/46)症状消失,无复发、死亡。结论全胸腔镜解剖性肺段切除治疗结核性支气管扩张症安全、可行,值得临床推广。

Objective To explore the feasibility of total thoracoscopic anatomical segmental resection for the treatment of tuberculous bronchiectasis. Methods A retrospective study of clinical data of 46 patients with tuberculous bronchiectasis treated with anatomical segmentectomy under total thoracoscope in our hospital from January 2014 to February 2018 was made. The operating hole was located at the fourth or fifth intercostal space on the anterior axillary line. The incision protector was used instead of rib retractor. The observation hole was located at seventh intercostal space on the axillary midline or the eighth intercostals space on the rear axillary line. The thoracoscopic pulmonary segmental resection was completed. Results No conversion to open surgery was needed. One patient was given lobectomy. The other 45 patients underwent video-assisted thoracoscopic operation,including 14 cases of right upper tip posterior segment of lung,6 cases of right lower lobe back section,2 cases of basal segment of the right lower lobe,15 cases of left lung tip on before and after the section,2 cases of left lung on leaf tongue section,5 cases of left lower lobe back section,and 1 case of basal segment of the left lower lobe. The time of operation was 100-330 min（ median,135 min）; the intraoperative blood loss was 100-650 ml（ median,230 ml）; the total drainage fluid after operation was 380-2250 ml（ median,550 ml）; the postoperative intubation time was 4-16 days（ median,5 days）; the postoperative hospital stay was 6-18 days（ median,9 days）. During peri-operative period there was no death. Postoperative complications occurred in 5 cases,including 3 cases of pulmonary air leakage,1 case of atelectasis,and 1 case of hemoptysis. All the patients were followed up for 1-36 months（ median,21 months）. The symptoms disappeared in 86. 9%（ 40/46） patients. No recurrence was found. Conclusions Total thoracoscopic anatomical segmental resection for the treatment of tuberculous bronchiectasis is safe and feasible. It is worthy of clinical application.