单孔胸腔镜肺段切除术治疗肺结节118例

Uniportal Video-assisted Thoracoscopic Anatomic Pulmonary Segmentectomy for Pulmonary Nodules:a Clinical Analysis of 118 Cases

目的探讨单孔胸腔镜肺段切除治疗肺部良恶性结节的可行性及安全性。方法回顾性分析2018年11月~2020年5月我院118例肺结节行单孔胸腔镜肺段切除的临床资料。CT提示肺磨玻璃结节97例,最大径0.6~2.0 cm,(1.1±0.5)cm,其中纯磨玻璃结节28例;实性结节21例,最大径0.9~3.0 cm,(1.9±0.8)cm。经腋前线第4或5肋间3 cm切口,胸腔镜下完成解剖性肺段切除术。结果2例中转肺叶切除,2例中转开胸,2例分别由左下肺外基底段、右下肺前基底段中转为基底段切除,其余112例顺利完成目标肺段切除。术后病理诊断恶性病变92例,良性病变26例。术后并发症9例,包括延迟性漏气5例,心律失常2例,咯血1例,切口感染1例。结论单孔胸腔镜肺段切除安全、可行,可以精准、微创切除肺结节。

Objective To explore the feasibility and safety of uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy in the treatment of benign and malignant pulmonary nodules.Methods A retrospective analysis was conducted on clinical data of 118 patients with pulmonary nodules undergoing uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy between November 2018 and May 2020 in our hospital.The CT indicated that there were 97 cases of ground glass nodules,with the maximum diameter of 0.6-2.0 cm[mean,(1.1±0.5)cm],among which there were 28 cases of pure ground glass nodules.There were 21 patients with solid nodules,with the maximum diameter of 0.9-3.0 cm[mean,(1.9±0.8)cm].Thoracoscopic anatomical segmentectomy was performed through an about 3 cm incision in the 4th or 5th intercostal of anterior line axillary.Results There were 2 patients converted to lobectomy,2 to thoracotomy,2 to basal pulmonary segmentectomy from external basal pulmonary segment of left lower lung and anterior basal pulmonary segment of right lower lung,and all the other 112 patients were successfully operated.Postoperative pathology showed malignant lesions in 92 cases and benign lesions in 26 cases.Postoperative complications occurred in 9 cases,including 5 cases of delayed leakage,2 cases of arrhythmia,1 case of hemoptysis and 1 case of incision infection.Conclusion The uniportal video-assisted thoracoscopic pulmonary segmentectomy for pulmonary nodules is safe,effective,feasible,and minimally invasive.