全胸腔镜支气管袖式肺叶切除术治疗中心型非小细胞肺癌效果及安全性

Efficacy and safety of thoracoscopic bronchial sleeve lobectomy for central non-small cell lung cancer

目的 探讨全胸腔镜袖式肺叶切除支气管成形术治疗中心型非小细胞肺癌(NSCLC)的效果,并对该术式的安全性进行评价。方法 回顾性分析2015年5月至2018年9月在山西省肿瘤医院行全胸腔镜袖式肺叶切除支气管成形术治疗的29例患者临床资料,对手术效果及安全性进行分析。结果 29例均行全胸腔镜袖式肺叶切除支气管成形术,其中行右肺上叶袖式13例,左肺上叶袖式10例,左肺下叶袖式6例。手术时间180~400 min,中位时间240 min,其中支气管吻合时间35~60 min,中位时间48 min。术中出血量150~460 ml,中位出血量220 ml。淋巴结清扫12~39枚/例,中位清扫19.6枚/例。术后放置胸腔引流管时间4~16 d,中位时间6 d;术后住院时间6~16 d,中位时间9 d。术后并发症发生率为24.1%(7/29),其中1例并发肺面漏气(>7 d),2例肺部感染,3例心律失常,1例患者术后第7天出院,第40天出现吻合口瘘出血死亡,其余患者术后恢复顺利。中位随访时间为6个月(3~12个月),未见肿瘤复发或吻合口狭窄。结论 全胸腔镜下支气管袖式肺叶切除术是治疗中心型NSCLC安全可行的手术方式。

Objective To explore the efficacy of thoracoscopic bronchial sleeve lobectomy for central non-small cell lung cancer(NSCLC),and to evaluate the safety of this operation.Methods The clinical data of 29 patients who underwent thoracoscopic bronchial sleeve lobectomy at Shanxi Provincial Cancer Hospital from May 2015 to September 2018 were retrospectively analyzed,and the surgical effect and safety were analyzed.Results Twenty-nine cases underwent thoracoscopic bronchial sleeve lobectomy.The types of resection included 13 cases of right upper,10 cases of left upper,and 6 cases of left lower sleeve lobectomy.The operation time was 180-400 min,and the median time was 240 min.The bronchial anastomosis time was 35-60 min,and the median time was 48 min.The intraoperative blood loss was 150-460 ml,and the median blood loss was 220 ml.The number of lymph node dissection was 12-39 lymph nodes per patient,with a median of 19.6 lymph nodes per patient.The thoracic drainage tube was placed for 4-16 days after operation,with a median of 6 days;the postoperative hospital stay was 6-16 days,with a median of 9 days.The postoperative complication rate was 24.1%(7/29),including 1 case with pulmonary air leakage(>7 days),2 cases with pulmonary infections,3 cases with arrhythmia,and 1 patient discharged from the hospital on the 7th day after surgery,but died of anastomotic fistula bleeding on the 40th day.The rest of the patients recovered smoothly after surgery.The median follow-up time was 6 months(3-12 months).No tumor recurrence or anastomotic stenosis was observed.Conclusion Thoracoscopic bronchial sleeve lobectomy is a safe and feasible surgical treatment for central NSCLC.