单孔胸腔镜下肺叶切除术的安全性评价

The safety evaluation of uni-portal completely thoracoscopic lobectomy

目的探讨单孔胸腔镜下肺叶切除术(单孔VATS)的安全性。方法回顾性分析2015年8月至2017年8月深圳宝安人民医院行单孔VATS治疗的86例患者临床资料,拟诊原发周围型肺癌81例,良性疾病(支气管扩张)5例,其中男性52例,女性34例;年龄32~82岁[(56.2±10.5)岁]。手术通过胸部前外侧单一微小切口,在全程非直视下完成解剖性肺叶切除恶性肿瘤,同时施行淋巴结清扫。包括右肺上叶切除21例,右肺中叶切除6例,右肺下叶切除18例,左肺上叶切除19例,左肺下叶切除22例。结果所有患者均顺利完成单孔VATS,行肺叶切除、淋巴结清扫,无中转开胸患者,无围术期死亡患者。术后诊断:原发性肺癌80例,透明细胞癌肺转移1例,支气管扩张5例。术后2例患者(2.33%)发生肺不张,经短暂呼吸机辅助呼吸和保守治疗后痊愈,无二次手术。所有患者均未出现严重并发症或围手术期死亡。除2例需短暂呼吸机支持及1例高龄体弱者,其余83例患者均在术后第1天即下床活动并开始有效咳痰。手术耗时84~210 min,[(116.2±64.8)min];术中出血量60~770 m L,[(310±460)m L],术中输血10例(11.63%)。术后胸腔引流留置时间为(5.8±4.2)d,住院时间为(8.5±4.0)d。所有患者出院后继续随访1~24个月,在原发性肺癌患者中2例(2.33%)分别于术后20个月和4个月发生远处转移,其余患者无复发、转移。结论单孔VATS能够完成肺叶切除术、淋巴结清扫,创伤小、恢复快,是一种安全、有效、微创的术式,适于经选择的早期周围型肺癌和需要肺叶切除的良性疾病患者。

Objective To investigate the safety and efficacy of completely uni-portal thoracoscopic lobectomy( Uni-portal VATS) and the indications of this procedure. Methods The clinical data of 86 consecutive patients( 52 men,34 women,median age 56. 2 ± 10. 5 years,range from 32 to 82 years)underwent Uni-portal VATS in the People's Hospital of Bao An of shen zhen city from Aug. 2015 to Aug.2017 were retrospectively analyzed. All candidates were either peripheral pulmonary nodules suspected of lung cancer( 81 pts) or benign lesions( 5 pts) localized within single lobe who needed to receive lobectomy.The lobectomy was completed through uni-portal incisions in the intercostal space. Anatomic lobectomies were carried out in all cases and systemic lymph node dissection was performed in malignancies. This group consisted of lobectomies of right upper lobe( n = 21),right middle lobe( n = 6),right lower lobe( n = 18),left upper lobe( n = 19),and left lower lobe( n = 22). Results All procedures were successfully completed except for 2 conversions to thoracotomy. Postoperative diagnosis were primary lung cancer( n =80),metastasis of clear cell carcinoma from kidney( n = 1),and,benign lesions( n = 5). 2 patients had mild complications,atelectasis,needed temperately mechanical ventilation. All were treated conservatively without re-operation. No operative mortality or serious complications occurred in this group. The operative duration was 116. 2 ± 64. 8 min( range from 84 to 210 minutes). The blood loss was 310 ± 460 m L( range from 60 to 770 m L),and two cases needed blood transfusion. Chest drainage time was 5. 8 ± 4. 2 days.Postoperative hospital stay was 8. 5 ± 4. 0 days. Followed-up time was for 1 to 24 months,metastasis happened in two patients with primary lung cancer 20 and 4 months separately after operation. Conclusion Uni-portal VATS is a safe and feasible surgical procedure with minimal invasiveness. The advocated indications include selected peripheral typed early stage lung cancer and benign pulmonary lesions which need lobectomy.