经下肺韧带方向胸腔镜单向式肺后外基底段切除的应用

Application of thoracoscopic unidirectional posterolateral basal segmentectomy via inferior pulmonary ligament

目的分享经下肺韧带方向胸腔镜单向式肺后外基底段切除术的临床应用经验。方法回顾性分析2015年12月至2018年10月32例行胸腔镜单向式肺后外基底段切除术患者的临床资料,其中男8例、女24例,年龄13~71(52.6±13.7)岁。所有患者健侧卧位,于腋中线第8肋间做腔镜孔,腋前线第5肋间做2~3 cm操作孔,经下肺韧带向上依次离断后外基底段静脉、支气管、动脉完成解剖性肺段切除。结果所有患者均顺利完成手术,包括左下肺后外基底段9例,右下肺后外基底段23例,手术时间80~295(133.4±40.5)min,术中出血量20~300(52.6±33.8)mL,术后胸腔引流时间2~14(4.2±2.3)d,术后住院时间4~15(6.9±2.4)d,住院期间无死亡病例,术后并发症包括1例术后肺不张,2例肺持续性漏气长于3 d(分别为4 d和6 d),1例术后乳糜胸,经均保守治疗后痊愈。术后病理提示原发性腺癌或非典型腺瘤样增生29例,包括原位腺癌5例,微浸润腺癌9例,浸润性腺癌12例,非典型腺瘤样增生3例。切除淋巴结3~21(9.6±4.6)枚,均未见肿瘤转移。肠道转移性腺癌1例,炎性病变1例,支气管扩张1例。结论经下肺韧带方向胸腔镜单向式肺后外基底段切除术操作简便,无需打开段间裂,可更好地保护肺组织,值得临床推广。

Objective To share the clinical experience of thoracoscopic unidirectional posterolateral basal segmentectomy via inferior pulmonary ligament.Methods All the patients were in the healthy lateral position,with endoscopy holes in the 8 th intercostal space of the middle axillary line and 2-3 cm operation holes in the 5 th intercostal space of the front axillary line.Anatomical segmentectomy of the posterolateral basal vein,bronchus and artery was performed through the inferior pulmonary ligament upward in turn.The clinical data of this group were analyzed retrospectively.Results From December 2015 to October 2018,32 patients underwent thoracoscopic unidirectional posterolateral basal segmentectomy,including 8 males and 24 females,aged 13-71(52.6±13.7)years.All patients successfully completed the operation,including 9 patients of left lower pulmonary posterolateral basal segmentectomy,23 patients of right lower pulmonary posterolateral basal segmentectomy.The operation time was 80-295(133.4±40.5)minutes,intraoperative bleeding volume was 20-300(52.6±33.8)mL,drainage time was 2-14(4.2±2.3)days,hospitalization time was 4-15(6.9±2.4)days.No death occurred during hospitalization.Postoperative complications included atelectasis in 1 patient and persistent pulmonary leakage over 3 days(4 or 6 days respectively)in 2 patients,chylothorax in 1 patient.All of them recovered smoothly after non-operative treatments.Postoperative pathology showed that 29 patients of primary adenocarcinoma or atypical adenomatoid hyperplasia,including 5 patients of adenocarcinoma in situ,9 patients of micro-invasive adenocarcinoma,12 patients of invasive adenocarcinoma,3 patients of atypical adenomatoid hyperplasia.One patient was of intestinal metastatic adenocarcinoma,1 patient of inflammatory lesion and 1 patient of bronchiectasis.3-21(9.6±4.6)lymph nodes were resected in the patients with primary pulmonary malignant tumors.And no metastasis was found.Conclusion The operation of thoracoscopic unidirectional posterolateral basal segmentectomy via inferior pulmonary ligament is easy.There is no need to open intersegmental tissue.It can protect lung tissue better.The operative method is worthy of clinical promotion.