胸腔镜肺段切除手术的安全性及降低耗材使用的临床分析

Clinical analysis of safety and reduce consumables of thoracoscopic pulmonary segmentectomy

目的探讨应用控制高值耗材使用的手术方式对胸腔镜肺段切除手术的安全性和疗效的影响。方法回顾性分析2018年12月-2019年12月蚌埠医学院第一附属医院胸外科收治的胸腔镜肺段切除术患者33例,其中男性6例,女性27例,年龄为31~75(55.33±10.25)岁;根据患者病变情况选择单肺段切除、联合肺段切除或肺段+肺楔形切除术式;通过以结扎为主的肺段动脉及静脉处理方法,保留段间静脉,膨胀萎陷法确定段间交界,将靶肺段通过能量器械从靶段中心向外周分离,切割缝合器完成剩余段间平面的裁剪;肺楔形切除以钳夹、切除后缝扎为主;通过个体化的手术方法,在保证手术安全性和疗效的同时,控制手术耗材的使用成本。结果33例患者均按照术前规划顺利完成手术;单肺段切除14例,联合肺段切除11例,肺段+肺楔形切除8例;切除病灶42个。减少了肺血管、肺楔形切除及段间平面处理的耗材使用量;能量器械处理段间平面处无明显漏气、出血,切割缝合器处理段间平面处无明显压榨;术后肺膨胀满意,总引流量为100~2330 mL;胸引管留置时间为2~18 d;术后住院天数为4~18 d。术后无严重并发症发生,6例轻度漏气者引流后痊愈。结论胸腔镜肺段切除通过控制手术耗材使用的手术方式,可以保证手术的安全性、经济性及短期疗效,更有利于手术的推广。

Objective To discuss the effect of the operation mode of controlling the use of high-value consumables on the safety and efficacy of thoracoscopic pulmonary segmentectomy.Methods A retrospective analysis of 33 patients who had thoracoscopic pulmonary segmentectomy in the Thoracic Surgery Department of the First Affiliated Hospital of Bengbu Medical College from December 2018 to December 2019 was conducted.The patients included 6 males and 27 females,with an age range of 31-75 years and an average age of(55.33±10.25)years.Depending on their lesions,the patients were subjected to single pulmonary segment resection,combined pulmonary segment resection or pulmonary segment+wedge resection.The veins between segments were retained by treating the pulmonary arteries and veins with ligation.The intersegmental boundary was confirmed using the expansion and collapse method,the target pulmonary segment was separated from the target centre to the periphery with the energy instruments.The remaining intersegmental plane was cut with the cutting and stitching instrument.The pulmonary wedge was resected with the clamp and stitched after resection.The cost of surgical consumables was controlled through individualised methods,whereas the operation safety and efficacy were ensured.Results Operation was successfully completed for the 33 patients,which was in line with the pre-operative plan.Of the 33 patients,14 underwent single pulmonary segment resection,11 underwent combined pulmonary segment resection and 8 underwent pulmonary segment+wedge resection;42 lesions were resected.The use of consumables for pulmonary vascular resection,wedge resection and intersegmental plane treatment was reduced.No apparent air leakage and haemorrhage were observed at the intersegmental plane treated with energy instruments,and no apparent pressing was found at the intersegmental plane treated with the cutting and stitching instrument.The post-operative pulmonary expansion was satisfactory,with a total drainage volume of 100-2330 mL,an indwelling time of chest drainage tube of 2-18 days and a post-operative LOS of 4-18 days.No serious complication occurred after operation,and 6 patients with slight air leakage were recovered after drainage.Conclusion Thoracoscopic pulmonary segmentectomy can ensure the operation safety,economy and short-term efficacy by the operation mode of controlling the use of surgical consumables,which is conducive to the promotion of the operation.