单中心全胸腔镜下全肺切除术治疗肺恶性病变的围手术期安全性及中期预后分析

Perioperative safety and prognosis analysis of cases underwent total thoracoscopic pneumonectomy for pulmonary malignancy in single center

目的探讨全肺切除术治疗肺部恶性疾病的围手术期安全性及有效性。方法回顾性分析2013年12月至2017年8月在上海市肺科医院全肺数据库中完成的全胸腔镜下全肺切除术的43例恶性病变患者的病例资料,对全胸腔镜组病例的病死率、并发症情况及疾病复发情况进行描述性分析及总结。结果43例患者均为恶性病变,其中非小细胞肺癌39例,小细胞肺癌3例,肺转移瘤1例。43例均行完全胸腔镜下全肺切除术,手术时间(181.1±68.0)min,出血量(146.5±113.6)ml,术后留置胸腔引流管(8.4+3.4)天,围手术期死亡1例,病死率2.3%(1/43);3级及以上并发症发生率16.3%;中位随访18个月,出现局部复发及远处转移9例,癌症相关死亡6例,非癌症相关死亡I例。结论对于严格挑选的局部晚期病例,全胸腔镜全肺切除术作为开胸手术的替代,可获得较好的围手术期安全性及中期预后。

Objective To investigate the safety and efficacy of total thoracoscopic pneumonectomy for malignant lesion from a single-center pneumonectomy database. Methods A retrospectively analysis of 43 cases of malignant lesions in patients underwent total thoracoscopic pneumonectomy from surgical database of Shanghai Pulmonary Hospital from December 2013 to August 2017 was conducted, and then the mortality, complications, and disease recurrence were summarized. Results All lesions in 43 patients were pathologically conifirmed malignant, including 39 non-sniall cell lung cancers and 3 small cell lung cancers and 1 pulmonary metastasis. Complete thoracoscopic pneumonectomy was performed in 43 patients. The average operation time was( 181.1 ± 68.0) min, blood loss was( 146. 5 ± 113. 6) ml, mean tube length was(8.4 ±3.4) days. Perioperative mortality was 2. 3%(1/43 ). The complication rate of grade 3 or above was 16. 3%. Median follow-up was 18 months, with 9 cases occurring local recurrence or distant metastasis;6 cases suffered from cancer-related death while non-cancer related death happened in 1 patient. Conclusion For selected locally advanced pulmonary malignant lesion, total thoracoscopic pneumonectomy is an alternative to open thoracic surgery with a better perioperative safety and satisfied mid-term oncologic survival.