单孔胸腔镜双袖式肺叶切除手术的临床分析

Clinical analysis of uniportal video-assisted thoracoscopic double-sleeve lobectomy

目的探讨单孔胸腔镜双袖式肺叶切除的手术方法、效果及临床推广价值。方法分析2016年12月至2018年7月同济大学附属上海市肺科医院连续收治的19例单孔胸腔镜双袖式肺叶切除手术患者的临床资料,其中左侧18例、右侧1例,统计分析手术患者的各项术前、术中和术后指标,并对患者进行随访观察。结果19例患者中男性17例、女性2例,平均年龄为(62.3±6.6)岁,平均手术时间为(258.0±66.6)min,平均手术失血量为(210.0±157.8)mL,平均支气管吻合时间为(26.0±5.8)min,平均血管吻合时间为(47.7±7.2)min,平均术后住院时间为(7.6±4.5)d。术后病理结果显示鳞癌15例,腺癌2例,小细胞癌1例,大细胞癌1例;TNM分期Ⅲa期11例,Ⅲb期8例。术后发生并发症的患者有4例,包括术后血管吻合口血栓形成1例,心律失常1例,术后漏气2例;无支气管吻合口瘘和吻合口狭窄,无血管吻合口狭窄,无手术死亡。术后平均随访(16.4±6.4)个月,均未见肿瘤复发或转移。结论单孔胸腔镜双袖式肺叶切除术是一项技术难度较大的手术,该手术在腔镜技术成熟的中心是安全、可行的,其能够彻底切除肿瘤和最大程度保留肺功能,并且可以减少手术创伤,实现患者快速康复。

Objective To explore the surgical technique and effectiveness of uniportal video-assisted thoracoscopic double-sleeve lobectomy and its clinical popularization value.Methods The clinical data of 19 consecutive patients(18 left-sided operations and 1 right-sided operation),who underwent uniportal video-assisted thoracoscopic double-sleeve lobectomy in Shanghai Pulmonary Hospital of Tongji University between Dec.2016 and Jul.2018,were included.Pre-,intra-and post-operative indicators were statistically analyzed,and the surgical patients were followed up.Results Among 19 patients,there were 17 males and 2 females,with an average age of(62.3±6.6)years.The average operative time was(258.0±66.6)min,average operative blood loss was(210.0±157.8)mL,average bronchus anastomosis time was(26.0±5.8)min,average artery anastomosis time was(47.7±7.2)min,and average postoperative hospital stay was(7.6±4.5)d.Postoperative pathologic examination indicated that 15 cases had squamous cell carcinoma,2 had adenocarcinoma,1 had small cell carcinoma,and 1 had large cell carcinoma.TNM staging:11 cases wasⅢa and 8 wasⅢb.Four patients suffered postoperative complications,including 1 case of thrombosis at the vascular anastomosis,1 arrhythmia and 2 prolonged airleak.There were no bronchial anastomotic fistula and anastomotic stenosis,vascular anastomosis stenosis or operative death.The average followup time was(16.4±6.4)months and no tumor recurrence or metastasis was found during follow-up after operation.Conclusion Uniportal video-assisted thoracoscopic double-sleeve lobectomy is a technique-demanding operation,which can be carried out in the thoracic centers with endoscopy proficiency.It is feasible for completely removing tumor,preserving lung function to the greatest extent,and reducing surgical trauma to achieve rapid recovery of patients.