单操作孔胸腔镜肺段切除治疗高龄肺结节患者临床疗效分析

Clinical analysis of single-port thoracoscopic segmentectomy for elderly patients with pulmonary nodules

目的:探讨单操作孔胸腔镜肺段切除在高龄肺结节患者中的应用经验。方法:2016年5月至2017年12月共对32例70岁以上肺结节患者行单操作孔胸腔镜下肺段切除,其中男性23例,女性9例;年龄71～85(75.6±6.5)岁;所有患者健侧卧位,于腋中线第7或第8肋间做腔镜孔,腋前线第3～4肋间做2～3 cm操作孔,行解剖性肺段切除。结果:所有患者均顺利完成手术,包括右上肺尖段切除5例,右上肺后段切除6例,右上肺前段切除4例,右下肺背段切除5例,左上肺尖后段切除5例,左上肺舌段切除3例,左下肺背段切除4例,肺结节直径7～22(13.6±6.3) mm,手术时间42～166(86.6±36.3) min,术中出血50～200(85.5±54.8) mL,术后住院时间4～8(5.6±3.3) d。住院期间无死亡病例,1例术后肺不张,1例肺持续性漏气大于3 d,经治疗后痊愈,其余均顺利恢复。结论:单操作孔全胸腔镜下肺段切除创伤小,并发症少,有利于高龄肺结节患者术后恢复。

Objective:To share the clinical experience of single-port thoracoscopic segmentectomy for elderly patients with pulmonary nodules. Methods:From May 2016 to December 2017, a total of 32 patients with pulmonary nodules and aged over 70 years underwent single-port thoracoscopic segmentectomy, including 23 males and 9 females. The patients’ age was 71-85 (75.6 ± 6.5) years;All patients were in healthy lateral position, and the endoscopy was performed on the 7th or 8th floor of the midaxillary line, and 2-3 cm operation holes were made between the 3-4 intercostal lines in the axillary front, and the anatomical pulmonary segment was resected. Results:The surgery was successfully completed in all patients, including upper right lung resection in 5 cases, upper right after lung resection in 6 cases, upper right lung resection in 4 cases, due back right lower lobe resection in 5 cases, left upper lung tip after resection in 5 cases, left pulmonary tongue resection in 3 cases, and lower left lung resection in 4 cases. The pulmonary nodule diameter was 7-22 (13.6±6.3) mm, operation time, 42-166 ( 86.6± 36.3) min, intraoperative bleeding, 50-200 (85.5±54.8) mL, postoperative hospital stay, 4-8 (5.6±3.3) days, there were no deaths during hospitalization, but 1 case of postoperative atelectasis, 1 case of pulmonary continuous leakage that is more than 3 days, and recovered after treatment, and all the others recovered smoothly. Conclusions:The single-port thoracoscopic lung segmental resection has less trauma and fewer complications, which might be beneficial to the postoperative recovery of elderly patients with pulmonary nodules.