单操作孔胸腔镜手术治疗肺隔离症的临床体会

Clinical experience of single⁃port thoracoscopic surgery in the treatment of pulmonary sequestra⁃tion

目的总结单操作孔胸腔镜手术治疗肺隔离症的临床经验,评价其安全性、有效性。方法回顾性分析2015年1月至2019年5月共21例单操作孔胸腔镜手术治疗的肺隔离症患者临床资料,其中男性10例,女性11例,年龄21~57(39.5±9.2)岁,21名患者均为下肺病变,包括左下肺13例,右下肺8例;叶外型1例,叶内型20例,术前均行增强CT扫描和三维重建;双腔气管插管全麻下单操作孔胸腔镜行肺叶或肺段切除20例,中转开胸1例。结果胸腔严重粘连者8例,行下肺叶切除术20例,下肺后基底段切除1例;手术均顺利完成,手术时间(167.3±61.5)min,术中出血量(157.3±30.2)mL,术后带管时间(5.3±1.6)天,术后住院时间(6.2±1.5)天,围手术期无死亡及严重并发症发生;随访21例无失访,随访时间7~59个月,21例患者复查胸片或CT无复发。结论单操作孔胸腔镜手术治疗肺隔离症安全可行,术前合理的检查评估和术中对隔离肺异常血管的合理处理是手术成功的关键。

Objective To summarize the clinical experience of single⁃port thoracoscopic surgery in the treatment of pulmonary sequestration,and to evaluate the safety and effectiveness.Methods A total of 21 patients with pulmonary sequestration treated by single⁃port thoracoscopic surgery from January 2015 to May 2019 were retrospectively analyzed,including 10 males and 11 females,aged from 21 to 57(39.5±9.2)years.The lesions of patients all located in the lower lung,including 13 cases in left lower lung and 8 cases in right lower lung.All cases were intrapulmonary sequestration except one were extra⁃pulmonary sequestration.Lobectomy or segmental pulmonary resection was performed by thoracoscopy in 20 cases under general anesthesia with double lumen endotracheal intubation.One case was transferred to thoracotomy.Enhanced CT scan and 3D reconstruction were performed before operation.Results All operations were performed successfully,including 8 cases of severe adhesion of chest cavity.There were 20 patients underwent inferior lobectomy and 1 patient underwent posterior basal segment resection of the lower lung.The median operative time was(167.3±61.5)minutes,and the median intraoperative blood loss was(157.3±30.2)mL,the median postoperative catheter duration was(5.3±1.6)days,and the median postoperative hospital stay was(6.2±1.5)days.There were none death or serious complications occurred during the perioperative period.The follow⁃up time was 7~59 months,and there was no loss of follow⁃up.Reexamination of chest radiographs or CT showed no recurrence in all patients.Conclusion Single⁃port thoracoscopic surgery is safe and feasible in the treatment of pulmonary sequestration.Proper examination and assessment preoperative,and proper management of the abnormal vessel are the keys to successful operation.