基于“流域分析”的解剖性部分肺切除术在早期周围型肺癌中的应用

Application of the Anatomical Partial Lobectomy Based on“Watershed Analysis”in the Treatment of Early-stage Peripheral Lung Cancer

目的探讨基于“流域分析”的解剖性部分肺切除术在早期周围型肺癌治疗中的可行性。方法回顾性分析2021年9月~2022年3月单治疗组23例胸腔镜下解剖性部分肺切除术资料。术前行三维重建,明确结节所在流域的动脉及切除范围,行单操作孔胸腔镜手术,离断靶动脉,无需处理支气管,然后行荧光反染,切除肺实质。结果23例均顺利完成手术,无扩大切除,无中转肺叶切除。手术时间(138.4±35.0)min,术中出血量(30.0±19.7)ml,术后引流时间(2.3±0.9)d,术后住院时间(4.6±1.4)d,肿瘤最大直径(1.0±0.3)cm。切除淋巴结(3.2±1.3)枚,均未见肿瘤转移。术后并发症3例,无死亡。结论基于“流域分析”的解剖性部分肺切除术对于早期周围型肺癌的切除安全、可行。

Objective To investigate the feasibility of the anatomical partial lobectomy based on“watershed analysis”in the treatment of early-stage peripheral lung cancer.Methods Clinical data of 23 patients with early-stage peripheral lung cancer who underwent anatomical partial lobectomy based on“watershed analysis”between September 2021 and March 2022 were retrospectively reviewed.Before operation,three-dimensional reconstruction was performed to identify the arteries in the range where the nodule was located and the scope of resection.The single utility port video-assisted thoracic surgery was performed.The target pulmonary artery was cut while preserving segmental bronchus,then a wedge resection was performed with indocyanine green fluorescence negative staining.Results All the patients underwent basal segmentectomy successfully with no conversion to multi-portal procedure or thoracotomy.The average operation time was(138.4±35.0)min,the average intraoperative blood loss was(30.0±19.7)ml,the average drainage time was(2.3±0.9)d,and the average postoperative hospital stay was(4.6±1.4)d.The average maximum diameter of the lesion in the resected basal segment was(1.0±0.3)cm.The average number of resected lymph nodes was(3.2±1.3).There was no evidence of nodal metastases.Three patient suffered postoperative complications.No perioperative death occurred.Conclusion The anatomical partial lobectomy based on“watershed analysis”in the treatment of early-stage peripheral lung cancer is safe and feasible.