单孔胸腔镜联合三维血管支气管CT成像在解剖性肺段切除中的应用

Application of single-port thoracoscopy combined with three-dimensional CT bronchography and angiography in anatomical segmentectomy of lungs

目的探讨单孔胸腔镜联合三维血管支气管CT成像(3D-CTBA)在解剖性肺段切除中的应用价值。方法选取行单孔胸腔镜解剖性肺段切除术的46例肺部小结节患者为研究对象,对其临床资料进行回顾性分析。结果所有患者术前均行3D-CTBA,均在单孔胸腔镜下行肺段切除术,无中转开胸,无扩大肺叶切除,无围术期死亡。手术时间为(139.3±32.5)min,术中出血量为(84.5±45.3)mL,术后胸管拔管时间为(5.5±1.3)d,术后住院时间为(7.1±2.8)d,淋巴结清扫数目为(10.2±3.4)枚。术后病理为原发性肺腺癌39例,转移性癌3例,肉芽肿4例。术后2例肺漏气大于5 d,经持续引流后好转;2例肺部感染,抗感染治疗后好转;3例心律失常。结论单孔胸腔镜联合3D-CTBA解剖性肺段切除术安全性、可行性较好,有利于患者快速康复。

Objective To investigate the application value of single-port thoracoscopy combined with three-dimensional CT bronchography and angiography(3 D-CTBA)in anatomical segmentectomy of lungs.Methods A total of 46 patients with pulmonary nodules who underwent single-port thoracoscopic anatomical segmentectomy and their clinical data were retrospectively analyzed.Results All patients underwent 3 D-CTBA before operation,and segmentectomy was performed under single-port thoracoscopy without thoracotomy,extended lobectomy and perioperative death.The operative time was(139.3±32.5)min,the intraoperative blood loss was(84.5±45.3)mL,the postoperative chest tube extubation time was(5.5±1.3)days,the postoperative hospital stay was(7.1±2.8)days and the number of lymph nodes dissected was(10.2±3.4).Postoperative pathology showed primary lung adenocarcinoma in 39 cases,metastatic carcinoma in 3 cases and granuloma in 4 cases.After operation,two patients had pulmonary air leakage more than 5 days,which was improved after continuous drainage;two cases had pulmonary infection,and were improved after anti-infection treatment;arrhythmia occurred in 3 cases.Conclusion Single-port thoracoscopy combined with 3 D-CTBA anatomical segmentectomy is safe and feasible,which is conducive to the rapid recovery of patients.