同期双侧电视胸腔镜手术治疗肺癌合并对侧孤立性肺结节的安全性和可行性探讨

Safety and feasibility of simultaneous bilateral video-assisted thoracoscopic surgery for lung cancer combined with contralateral solitary pulmonary nodule

目的探讨同期双侧电视胸腔镜手术(VATS)治疗肺癌合并对侧孤立性肺结节(SPN)的安全性和可行性。方法110例肺癌合并对侧SPN患者作为研究对象,先对SPN侧进行VATS手术治疗,当SPN侧手术完成后,翻身对侧卧位行对侧肺癌根治术治疗。分析手术结果、术后各项指标,比较患者手术前后血气指标,记录患者术后不同时间段(术后1、2、3年)生存率。结果110例患者中,有108例患者顺利完成了VATS肺楔形切除术或肺段切除术,2例患者中转开胸,患者平均手术时间(175.95±39.50)min,平均失血量(70.13±13.28)ml。110例患者其主要病变侧均采取肺癌根治术治疗,平均手术时间(141.50±52.16)min,平均失血量(53.20±29.56)ml,淋巴结清扫数量(17.20±4.19)个。110例患者均顺利完成手术,17例患者手术室苏醒后直接脱机,术后93例患者带气管插管,留住重症加强护理病房(ICU)进行呼吸机辅助呼吸,呼吸机使用时间(5.10±1.38)h,术后有2例患者出现肺部感染、发生率为1.82%,1例患者出现呼吸衰竭、发生率为0.91%,围术期无死亡患者。患者平均胸管拔除时间(3.07±1.52)d,平均住院时间(13.45±2.38)d。术后1、3 d的动脉血氧分压(PaO_(2))分别为(78.95±4.62)、(82.13±4.85)mm Hg(1 mm Hg=0.133 kPa),均低于术前的(88.63±3.49)mm Hg;术后1 d的血氧饱和度(SpO_(2))(91.02±4.31)%低于术前的(97.46±1.78)%,差异均具有统计学意义(P<0.05)。患者术后7 d的PaO_(2)水平与术前比较,术后3、7 d的SpO_(2)与术前比较,术后1、3、7 d的动脉血二氧化碳分压(PaCO_(2))与术前比较,差异均无统计学意义(P>0.05)。对患者进行为期3年的术后随访,110例患者1年生存率为100.00%(110/110),2年生存率为91.82%(101/110),3年生存率为73.64%(81/110)。结论同期双侧VATS能够对肺癌合并对侧SPN做出准确的诊断和分期,为患者提供最佳的治疗的方案。

Objective To discuss the safety and feasibility of simultaneous bilateral video-assisted thoracoscopic surgery(VATS)for lung cancer combined with contralateral solitary pulmonary nodule(SPN).Methods There were 110 patients with lung cancer and contralateral SPN taken as the research subjects.The SPN side was first treated by VATS,and when the surgery on the SPN side was completed,they were turned over and performed lateral contralateral radical resection of lung cancer.The surgical results and various postoperative indicators were analyzed,and the blood gas indicators before and after the operation were compared,and the survival rate of the patients at different time periods(at 1,2,3 years postoperatively)was recorded.Results Among 110 patients,108 patients successfully completed VATS pulmonary wedge resection or segmental lung resection,and 2 patients were converted to open chest,with mean operation time of(175.95±39.50)min and mean blood loss of(70.13±13.28)ml in patients.All 110 patients were treated with radical lung cancer on their major lesion side,with mean operation time of(141.50±52.16)min,mean blood loss of(53.20±29.56)ml,and number of lymph node dissection of(17.20±4.19)nodes.110 patients all completed the surgery successfully,17 patients were taken offline directly after waking up in the operation room,and 93 patients were intubated with trachea after surgery,kept in the intensive care unit(ICU)for ventilator-assisted breathing,and the time on ventilator was(5.10±1.38)h.2 patients developed pulmonary infection after surgery,with incidence rate of 1.82%,and 1 patient developed respiratory failure,with an incidence of 0.91%,and no patients died in the perioperative period.The mean chest tube removal time of the patients was(3.07±1.52)d and the mean hospitalization time was(13.45±2.38)d.The arterial partial pressure of oxygen(PaO_(2))at 1 and 3 d after surgery were(78.95±4.62)and(82.13±4.85)mm Hg(1 mm Hg=0.133 kPa)respectively,which were lower than(88.63±3.49)mm Hg before surgery,and the blood oxygen saturation(SpO_(2))(91.02±4.31)%at 1 d after surgery was lower than(97.46±1.78)%before surgery.All the differences were statistically significant(P<0.05).There were no statistically significant differences in PaO_(2) levels in patients at 7 d after surgery compared with that before surgery,SpO_(2) at 3 and 7 d after surgery compared with that before surgery,and arterial blood carbon dioxide partial pressure(PaCO_(2))at 1,3,and 7 d after surgery compared with that before surgery(P>0.05).Patients were followed up for 3 years after surgery,and the 1-year survival rate was 100.00%(110/110),the 2-year survival rate was 91.82%(101/110),and the 3-year survival rate was 73.64%(81/110)in 110 patients.Conclusion Simultaneous bilateral VATS can make accurate diagnosis and staging of lung cancer combined with contralateral SPN,and provide the best treatment plan for patients.