胸腔镜精准肺段切除治疗肺部磨玻璃样结节的临床效果观察

Observation on clinical effect of thoracoscopic precise pulmonary segmentectomy in the treatment of pulmonary ground-glass nodules

目的观察胸腔镜精准肺段切除治疗肺部磨玻璃样结节的临床效果。方法回顾性分析行胸腔镜下精准肺段切除治疗的61例肺部磨玻璃样结节患者的临床资料,术前均应用Mimics软件行三维计算机断层扫描支气管血管成像(3D-CTBA),辨认靶段血管及支气管,规划手术路径。分析患者的手术相关指标、术后并发症、术后病理结果及随访情况。结果61例患者均在胸腔镜下完成手术,无中转开放手术。手术时间为(157.2±32.2)min,术中出血量为(31.6±28.4)mL,术后胸管平均留置时间4 d,术后平均住院时间为7 d。非小细胞肺癌(NSCLC)患者常规行淋巴结采样,共采样淋巴结448枚,平均(8.3±3.7)枚,均未见淋巴结转移。术后并发症:肺部感染1例,乳糜胸1例,肺漏气6例,少量咯血2例,心律失常3例。61例患者中,良性肺结节8例(其中1例患者两处肺结节病理分别为非典型腺瘤样增生及软骨瘤);恶性肺结节53例,其中转移性肺癌2例,NSCLC 51例。对59例手术患者(2例转移性肺癌患者除外)定期随访,随访时间12~36个月,其间无远处转移或复发病例,无死亡病例。结论对肺部磨玻璃样结节在3D-CTBA技术支持下行胸腔镜下精准肺段切除,有利于术者在术前详细规划手术方案、术中精细操作,从而降低手术风险及并发症发生率,提高患者生活质量,是一种安全有效的治疗方式,值得推广应用。

Objective To observe the clinical effect of thoracoscopic precise pulmonary segmentectomy in the treatment of pulmonary ground-glass nodules.Methods The clinical data of 61 patients with pulmonary ground-glass nodules who underwent thoracoscopic precise pulmonary segmentectomy were analyzed retrospectively.Before operation,three-dimensional computed tomography bronchography and angiography(3D-CTBA)was performed with Mimics software to identify the target vessels and bronchus,and to plan the surgical approach.The operation related indexes,postoperative complications,postoperative pathological results and follow-up were analyzed in patients.Results The operations completed in 61 patients via thoracoscopy,without conversion to the open operation.The operation time was(157.2±32.2)min,the intraoperative blood loss was(31.6±28.4)mL,the mean postoperative indwelling time of chest tube was 4 d,and the mean postoperative hospital stays were 7 d.The patients with non-small cell lung cancer(NSCLC)underwent routine lymph node sampling.A total of 448 lymph nodes were sampled,with an average of(8.3±3.7).No lymph node metastasis was found.Postoperative complications expressed as 1 case of pulmonary infection,1 case of chylothorax,6 cases of pulmonary air leakage,2 cases of a small amount of hemoptysis,and 3 cases of arrhythmia.Among the 61 patients,8 cases interpreted in benign pulmonary nodules(two pulmonary nodules pathologies in one of the patients revealed atypical adenomatous hyperplasia and chondroma,respectively),and 53 cases had malignant pulmonary nodules,including 2 cases of metastatic lung cancer and 51 cases of NSCLC.A regular follow-up for 12 to 36 months was conducted in 59 patients with operation(2 patients with metastatic lung cancer were excluded).There was no distant metastasis or recurrence,and no death occurred in the patients during the follow-up period.Conclusion Employing thoracoscopic precise pulmonary segmentectomy on pulmonary ground-glass nodules with the support of 3D-CTBA technology is conducive to the operators to plan a detailed surgical scheme before operation,and to exquisitely conduct during operation,so as to reduce the risk of surgery,and to decrease the incidence of complications,as well as to improve the quality of life in patients.It is a safe and effective treatment method,which is worthy of promotion and application.