单孔胸腔镜技术的临床应用及学习曲线

Clinical application and learning curve of uniportal thoracoscopy

目的分析单孔胸腔镜手术的围术期结果,以及手术开展的学习曲线。方法回顾性分析2018年11月至2020年12月在华西医院上锦院区胸外科完成单孔胸腔镜手术148例患者的临床资料,其中男62例、女86例,平均年龄(50.1±13.4)岁。手术方式包括肺叶切除、肺段切除、肺楔形切除、纵隔肿物切除和血气胸止血等。并将单孔胸腔镜手术按照手术分类,进行分时段下的亚组分析,探讨对应的指标变化和学习曲线。结果患者中位术后住院时间为5 d,术后总体并发症发生率8.1%(12/148),无术后死亡。中位术后24 h疼痛评分3分。随着时间推移,单孔胸腔镜肺叶切除手术时间、单孔切口长度、术中出血量指标均在优化,单孔胸腔镜肺段切除切口长度和术中出血量均"逆向"增加,单孔胸腔镜肺楔形切除术后住院时间缩短。结论单孔胸腔镜手术在肺叶切除、肺段切除、肺楔形切除中的应用是安全可行的。对于具有较高胸腔镜水平的术者,学习曲线阶段指标差异不特别明显,较易在单孔胸腔镜手术实践中进入稳定状态。

Objective To analyze the operation outcomes and learning curve of uniportal video-assisted thoracoscopic surgery(VATS).Methods All consecutive patients who underwent uniportal VATS between November2018 and December 2020 in Shangjin Branch of West China Hospital of Sichuan University were retrospectively enrolled,including 62 males and 86 females with a mean age of 50.1±13.4 years.Operations included lobectomy,segmentectomy,wedge resection,mediastinal mass resection and hemopneumothorax.Accordingly,patients’clinical features in different phases were collected and compared to determine the outcome difference and learning curve for uniportal VATS.Results Median postoperative hospital stay was 5 days,and the overall complication rate was 8.1%(12/148).There was no 30-day death after surgery or readmissions.Median postoperative pain score was 3.Over time,the operation time,incision length and blood loss were optimized in the uniportal VATS lobectomy,the incision length and blood loss increased in the uniportal VATS segmentectomy,and the postoperative hospital stay decreased in the uniportal VATS wedge resection.Conclusion Uniportal VATS is safe and feasible for both standard and complex pulmonary resections.While,no remarkable learning curve for uniportal VATS lobectomy is observed for experienced surgeon.