单孔胸腔镜治疗高龄老年肺癌伴顽固性胸腔积液的临床疗效

The clinical effect of single port thoracoscopy in the treatment of senile lung cancer with intractable pleural effusion

目的探讨单孔胸腔镜治疗高龄老年肺癌伴顽固性胸腔积液的临床疗效。方法回顾分析2015年3月至2019年10月间收治的年龄≥75岁高龄老年肺癌伴顽固性胸腔积液患者30例,胸腔引流量≥200 m/d,持续2周。手术行单孔胸腔镜下壁层胸膜活检,部分肺肿瘤楔形切除,氲气刀烧灼胸膜转移瘤,自制喷洒器喷涵无菌滑石粉及顺铂干粉做胸膜固定,观察手术效果。结果手术时间45~72 min,平均(56.5±16.2)min,喷洒器制作时间2~3 min,术中出血20-65 ml,平均(45.6±22.8)ml,无中转开胸病例;术中壁胸膜活检28例,肺肿物楔形切除8例,术后腺癌23例,小细胞癌5例,鱗癌2例(术前非小细胞癌7例中,术后腺癌6例,鳞癌l例),较术前非手术诊断更精确;术后发热及胸痛发生于第2~7天,平均(4.6±2.2)天,术后第5天体温37.8~39.2℃,平均(38.5±0.7)℃,疼痛VAS评分4~8分,平均(6.8±1.2)分,引流6S~175 ml,平均(120±50)ml,较术前差异均有统计学意义(P<0.05),体温、疼痛在水后第10天恢复正常,胸管放置8~12d,平均(7.8±12)d;胸膜固定完全缓解(CR)23例,部分缓解(PR)5例,CR+PR 28例,有效率93.3%;术后愿意接受肿瘤治疗27例(90%),放弃治疗3例(10%),较术前比较差异有统计学意义(P<0.05)。结论单孔胸腔镜在高龄老年肺癌伴顽固性胸腔积液治疗中操作简单,安全有效,通过胸腔镜下活检与胸膜固定,获得了精确诊断与胸水治疗目的,为后续肿瘤综合治疗创造了条件。同时喷洒器制作简单、省时,值得临床上推广应用。

Objective To evalute the cinical eficacy of single port video-aseds thoracoscopic surgery in the treatment of elderly lung cancer and stubborn pleural efusion.Methods Clinical data of 30 aged 75 years old and over patients with lung cancer and stubborn pleural ffusion at our hospital from March 2015 to October 2019,thoracic drainage≥200 ml/d and continued 2 weeks.Pleural biopsy,wedge resection of lung nodules,Argon Knife treated pleural metastatic tumor,cisplatin and talcum powder were spraied to thonacic cavity by sef-made tool,those were operated by single port video-asted thoracoscopic surgery and the fectiveness were observed.Results The operation time was 45~72(56.5±16.2)min,among it made self-made tool 2~3 min,blood loss 20~65(45.6±228)ml and had not VATS to thoractomy cases.Pleural biopsy 28 cases,resection of lung nodules 8 ases intraoperative,and postoperative Adenocarcinoma 23cases,Small cell carcinoma 5 cases,Squamous cell carcinoma 2 cases,the pathological results were more accurate dhan non-operations Fever and chest pain were appeared 2~7(4.6±2.2)d postoperaive,the termperatuer 37.8-39.2(38.5±0.7)℃,VAS4-8(6.8±1.2),thoracic drainage 65~175(120±50)ml the 5th day after operstion,all the results mentioned above were stutisic lly signifcant than that of preoperative(P<0.05),the fever and chest pain back to nomal 10th day after operation.The fficacy of pleural fixation were CR 23 cases,PR 5 cases and the eficient 933%Efective treatment 27(90%)cases and abandon treatment 3(10%)after operation,and had stisically signifcant than preoperaive(P<0.05).Conclusion Safe and efective of single port vide-asisted thoracoscopic surgery in the treatment of elderly lung cancer and stubborn pleural efiusion,the precise diagnosis and pleural efusion are treated by pleural biopsy and fixation,which created conditions for cancer treament.Especially the self-made tool are simple and time--saving,and worthy of clinical promotion and application.