应用改良膨胀萎陷法行胸腔镜锥式肺段切除术146例  

Modified inflation-deflation for 146 thoracscopic cone-shaped segmentectomies

作　　者：吴卫兵[1] 朱全[1] 闻伟[1] 王俊[1] 许晶[1] 徐心峰 潘相龙 陈亮[1] 

机构地区：[1]南京医科大学第一附属医院,210029

出　　处：《中华胸心血管外科杂志》2017年第9期517-521,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：江苏省自然科学基金（BK20151584）,江苏省六大人才高峰基金（WSW-028）,江苏省社会发展基金--临床前沿技术（BE2016790）,江苏省医学创新团队（领军人才,CXTDA2017006）,江苏省333人才项目（BRA2017545）

摘　　要：目的 应用改良膨胀萎陷法确定肺段间交界,探索按照锥形结构原理自肺叶中完整分离肺段的方法,并评价技术可行性.方法 2013年9月至2016年8月,146例周围型肺结节患者行胸腔镜锥式肺段切除术,男52例,女94例,年龄（57±23）岁.在3D-CTBA（three-dimensional computed tomo-graphy bronchography and angiography）导航下切断靶段支气管、动脉后,采用改良膨胀萎陷法确定肺段间交界,沿段间静脉由段门向远端解剖分离膨胀萎陷交界面,当剩余段间肺实质厚度在1～2 cm时,使用腔镜切割缝合器切开段间肺实质.术后平均随访20.4个月.结果 实施单肺段切除术62例、联合肺段切除术38例、亚段切除术43例、次亚段切除术3例.病理为良性12例,腺瘤样不典型增生15例,转移癌6例,原发性肺癌113例.应用改良膨胀萎陷法出现清晰可辨的膨胀萎陷交界线的时间（12.5±6.4）min.准确切断靶段支气管、动脉,段间静脉均予保留,保留肺段膨胀后接近原始几何形状.肺结节直径（1.4±0.7）cm,切缘宽度（2.5±1.6）cm,分离肺段间交界的深度（4.2±1.7） cm,宽度（6.5±2.2）cm.平均手术时间（158.5 ±42.6） min,术中出血（25.2±15.7） ml,术后平均住院时间（5.2±2.2）天,并发症发生率5.5％ （8/146）,无术后30天死亡.113例原发性肺癌中35例原位腺癌（0期）,78例T1aNoMo（ⅠA期）非小细胞肺癌,随访期间1例局部复发,无死亡.结论 改良膨胀萎陷法界定的段间交界线清晰可辨,胸腔镜锥式肺段切除术可实现精准的完全解剖性肺段切除.Objective This study applied ＆quot; modified inflation-deflation＆quot; to identify the intersegmental plane and explored a method to remove pulmonary segments from the lobe on the basis of cone-shaped principle.＆quot;Cone-shaped＆quot; Segmentectomy includes anatomical separation of the hilum（conical tip） and the intersegmental plane（undissociative conical surface）.The feasibility was evaluated.Methods We retrospectively reviewed 146 patients with peripheric pulmonary nodules who underwent cone-shaped segmentectomy between September 2013 and August 2016.Under the guidance of preoperative 3D-CTBA （three-dimensional computed tomography bronchography and angiography）the targeted bronchi and arteries were dissected.The intersegmental plane was identified by ＆quot; modified inflation-deflation＆quot; method.The inflation-deflation interface was anatomically separated from hilum to distal region along the intersegmental veins,while leaving 1-2 cm in thickness from far end.The residual intersegmental parenchyma was then dissected using endo staplers.Mean folhow-up was 20.4 months.Results Sixty two single segmentectomies,38 combined segmentectomies,43 subsegmentectomies and 3 subsubsegmentectonies were performed.Twelve diagnoses of benign nodule,15 diagnoses of atypical adenomatous hyperplasia,6 diagnoses of metastatic carcinona and 113 diagnosis of primary puhmonary cancer were confirmed pathologically.＆quot; Modified inflation-deflation＆quot; spent （12.5 ±6.4）minutes to show the clear inflation-deflation line.All the targeted bronchi and arteries were dissected precisely and the intersegmental veins were preserved.All the preserved adjacent segments kept approximately original shape after inflated.The tumor size was（1.4 ±0.7）cm,the surgical margin width was（2.5 ± 1.6）cm.The depth of the separated intersegmental plane was（4.2 ±1.7）cm,and the width of the plane was（6.5 ± 2.2）cm.The operative time was（158.5 ± 42.6）min,the volume of hemorrhage was（25.2 ± 15.7） ml

关 键 词：硬币病变 肺 膨胀萎陷法 胸腔镜检查 肺切除术 

分 类 号：R734.2[医药卫生—肿瘤]