单孔胸腔镜解剖性基底段切除术的临床应用

Clinical application of uniportal video-assisted thoracoscopic surgery anatomic basal segmentectomy

目的分析单孔胸腔镜解剖性基底段切除术的临床应用结果。方法回顾性分析2020年6~12月我院单个医疗组15例行单孔胸腔镜基底段切除术患者的临床资料,其中男4例、女11例,中位年龄53(32~70)岁。所有患者均经跨腋中线第5肋间切口,经叶间裂或肺下韧带入路,采用"单向式"思路结合"干-支法"完成解剖性各基底段切除。结果所有患者均顺利完成手术,无中转为多孔胸腔镜手术或开胸手术者,无中转为肺叶切除者。中位手术时间120(90~160)min,中位术中出血量20(10~50)mL,中位术后引流时间3(2~5)d,中位术后住院时间4(4~10)d,基底段肿瘤中位最大直径1.2(0.7~1.9)cm。中位切除淋巴结7(5~12)枚,均未见肿瘤转移。术后并发症1例。全组无住院期间死亡。结论单孔胸腔镜下采用"单向式"方法完成解剖性基底段切除术思路清晰,安全可行。

Objective To investigate the efficacy of uniportal video-assisted thoracoscopic surgery(VATS)anatomic basal segmentectomy.Methods The clinical data of 15 patients who underwent uniportal VATS anatomic basal segmentectomy between June 2020 and December 2020 were retrospectively reviewed.There were 4 males and 11 females with a median age of 53(32-70)years.The incisions were placed in the fifth intercostal space across the midaxillary line.All basal segmentectomies were performed through the interlobar fissure or inferior pulmonary ligament approach following the strategies of single-direction and stem-branch.Results All patients underwent basal segmentectomy successfully with no conversion to multi-portal procedure or thoracotomy.The median operation time was 120(90-160)min,median intraoperative blood loss was 20(10-50)m L,median drainage time was 3(2-5)d,and median postoperative hospital stay was 4(4-10)d.The maximum diameter of the lesion in the resected basal segment was1.2(0.7-1.9)cm.The median resected lymph nodes were 7(5-12).There was no evidence of nodal metastases.One patient suffered postoperative atelectasis and subsequent pneumonia.No perioperative death occurred.Conclusion Uniportal VATS anatomic basal segmentectomy is feasible and safe.It can be performed in a simple manner following the strategy of single-direction.