支气管前方清扫隆突下淋巴结在单孔胸腔镜肺上叶癌根治手术中的应用

Application of anterior bronchus dissection of subcarinal lymph nodes in uniportal thoracoscopic radical lobectomy surgery for upper lobe lung cancer

目的探讨支气管前方清扫隆突下淋巴结在单孔胸腔镜肺上叶癌根治手术中的应用效果及安全性。方法回顾性分析北京大学第一医院胸外科2016年6月-2017年1月应用单孔胸腔镜技术行肺上叶癌根治手术的患者20例,对比该科室同期行单操作孔胸腔镜肺上叶癌根治手术的患者40例。比较两组患者术前、术中及术后的相关数据。结果两组患者在术后住院天数、术中出血量、术后总引流量、术后引流管留置时间和第7组淋巴结清扫数目等方面无明显差异;单孔胸腔镜组(支气管前方清扫隆突下淋巴结)在疼痛评分方面较单操作孔胸腔镜组(支气管后方清扫隆突下淋巴结)低,在肿瘤大小方面较单操作孔胸腔镜组(支气管后方清扫隆突下淋巴结)小,在手术时间方面较单操作孔胸腔镜组(支气管后方清扫隆突下淋巴结)短。两组患者均无术后严重并发症,无围手术期死亡病例,顺利出院。术后随访12个月,期间均无出血、肺不张、胸腔包裹性积液和支气管胸膜瘘等并发症,患者影像学复查无复发、转移情况。结论经支气管前方清扫隆突下淋巴结是一个可行的手术方案,在手术质量及安全性上得到了保证。

Objective To evaluate the efficacy and safety of anterior bronchus dissection of subcarinal lymph nodes in uniportal thoracoscopic radical lobectomy surgery for upper lobe lung cancer.Methods A retrospective study was conducted on 20 patients with upper lobe lung cancer who underwent thoracoscopic surgery from June 2016 to January 2017.40 cases of upper lobe lung cancer treated by single-hole thoracoscopic surgery at the same time were compared.Relevant data before,during and after operation were compared between the two groups.Results There was no significant difference in the number of days in hospital,blood loss during operation,total drainage volume after operation,indwelling time of drainage tube after operation and number of lymph nodes in group 7 between the two groups.The pain score,tumor size and operation time of uniport thoracoscopic lobectomy group(anterior bronchial dissection of subcarinal lymph nodes)were better than those of single-hole thoracoscopic operation group(posterior bronchial dissection).There were no major postoperative complications and no perioperative deaths in both groups,and they were discharged smoothly.There were no complications such as bleeding,atelectasis,pleural encapsulated effusion,bronchopleural fistula,and no recurrence or metastasis during the follow-up period of 12 months.Conclusion Anterior bronchus dissection of subcarinal lymph nodes is a feasible surgical procedure,which guarantees the quality and safety of the operation.