52例单孔胸腔镜解剖性肺段切除术临床分析和技术探讨  

Uniportal video-assisted thoraeoscopic anatomic segmentectomy for lung diseases： 52 cases report

作　　者：段亮[1] 朱余明[1] 胡学飞[1] 边栋亮 徐勇[1] 姜格宁[1] 

机构地区：[1]同济大学附属上海市肺科医院胸外科,200433

出　　处：《中华胸心血管外科杂志》2017年第4期208-211,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨单孔胸腔镜肺段切除临床应用的可行性和安全性。方法回顾性分析2015年3月至2015年12月52例单孔胸腔镜解剖性肺段切除术的临床资料。男16例，女36例；年龄32～82岁，平均52．7岁。于腋前线第4或第5肋间取长约2．5-4．0em切口，胸腔镜镜头及胸腔内所有手术操作均经该单一切口完成，分析围手术期各项数据。结果51例患者顺利完成单孔胸腔镜肺段切除手术，1例因胸腔广泛粘连行辅助切口。手术60-240min，平均125min；出血量10～300ml，平均60ml；术后住院2～14天，平均4．6天。无围手术期死亡患者，术后并发症7例（13．5％），其中术后咳血3例，皮下气肿、肺部感染、肺漏气时间过长、房颤各1例，经对症及对因治疗后，所有并发症均治愈。术后病理结果显示良性病变10例，非小细胞肺癌42例，其中原位腺癌和微浸润腺癌26例，浸润性腺癌、黏液腺癌及类癌共16例。结论单孔胸腔镜肺段切除术安全、可行，具有损伤肋间神经少以及视角好的优点。Objective To evaluate the feasibility and safety of uniportal Video-assisted thoracoscopicsurgery（VATS） an- atomic segmentectomy for lung diseases. Methods We performed a retrospective review of 52 patients undergoing uniportal VATS anatomic segmentectomy from Mar 2015 to Dec 2015. There were 16 males and 36 females with a mean age of 52.7 years （32 -82 years）. The incision, about 4 to 5 cm long, is performed at the fourth or the fifth intercostal space. The camera and the instruments are all through the single incision. Results Fifty-one patients underwent uniportal VATS segmentectomy saccessfully. 1 patient with extensive pleural adhesion was needed for auxiliary incision. The median operative time was 125 min （ 60 - 240 rain）, the median blood loss in operation was 60 ml （ 10 - 300 ml ） , the median hospital stay after operation was d. 6 days（2 - 14 days）. There was no perioperative mortality. Major morbidity occurred in 7 patients（ 13.5% ）. Pathological ex- amination showed that there were 10 cases of benign diseases and 42 cases of non-small cell lung cancer（ 26 cases of carcinoma in situ and micro invasive adenocarcinoma, 16 cases of infiltrating adenocarcinoma, mucinous adenocarcinoma and carcinoid）. Conclusion Uniportal VATS segmentectomy has the advantage of less intercostal nerve injury and good operative perspective. It is a safe and feasible procedure after surgery practice.

关 键 词：肺段切除术 单孔 胸腔镜 

分 类 号：R655.3[医药卫生—外科学]