单一切口胸腔镜下肺叶切除术治疗早期非小细胞肺癌66例分析  

Single-incision Thoracoscopic Lobectomy for Early Stage Non-small Cell Lung Cancer:Analysis of 66 Cases

作　　者：凌发昱 熊剑文[1] 喻东亮[1] 魏益平[1] 张文雄[1] 张五星[1] Ling Fayu;Xiong Jianwen;Yu Dongliang(Department of Thoracic Surgery,Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院胸外科,南昌330006

出　　处：《中国微创外科杂志》2018年第12期1069-1072,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：卫生部医药卫生科技发展研究中心课题(W2013R45)

摘　　要：目的探讨单一切口胸腔镜下肺叶切除术治疗早期非小细胞肺癌的安全性及临床价值。方法 2017年1～12月对66例T1N0M0～T3N0M0非小细胞肺癌(non-small cell lung cancer,NSCLC)行单一切口胸腔镜肺叶切除,取腋前线和腋中线间第3或4肋间做3～5 cm单一操作孔,全胸腔镜下完成肺叶切除和肺门、纵隔淋巴结清扫。结果 63例顺利完成单一切口VATS,3例因止血困难而中转多孔胸腔镜手术,无中转开胸及围术期死亡。8例左肺上叶切除,12例左肺下叶切除,25例右肺上叶切除,6例右肺中叶切除,15例右肺下叶切除。手术时间(113. 2±23. 5) min,术中出血(145. 3±22. 8) ml,清扫淋巴结(11. 5±2. 2)枚,术后胸腔引流量(515. 8±45. 2) ml,术后(3. 3±0. 5) d拔管,术后住院时间(10. 6±1. 2) d,术后疼痛程度NRS评分(2. 3±0. 6)分。术后并发肺炎6例,漏气2例,乳糜胸1例,切口感染2例,均经对症支持治疗后好转出院。术后病理:鳞癌23例,腺癌38例,腺鳞癌5例;临床病理分期Ⅰa期28例,Ⅰb期20例,Ⅱa期10例,Ⅱb期8例。66例随访3～15个月,平均12个月,均无复发、转移。结论单一切口胸腔镜肺叶切除治疗早期NSCLC安全可行,近期疗效满意。Objective To investigate the safety and clinical value of single-port thoracoscopic lobectomy for early non-small cell lung cancer( NSCLC). Methods Clinical data of 66 patients with stage Ⅰ-Ⅱ( T1N0M0-T3N0M0) NSCLC who underwent single-port thoracoscopic lobectomy from January 2017 to December 2017 in our hospital were retrospectively analyzed. A single operative incision 3-5 cm in length at the third or fourth intercostals space between the axillary front and middle line was taken. The complete lobectomy and hilar and mediastinal lymph node dissection were performed under thoracoscope. Results A total of 63 patients were successfully operated on,and 3 patients were converted to multi-port thoracoscopic surgery because of difficulty in hemostasis. There was no conversion to thoracotomy or peri-operative death. There were 8 cases of upper left lobectomy,12 cases of resection of lower lobe of left lung,25 cases of right upper lobectomy,6 cases of right middle lobectomy,and 15 cases of resection of lower lobe of right lung. The operation time was( 113. 2 ± 23. 5) min,the intraoperative bleeding was( 145. 3 ± 22. 8) ml,the number of lymph node dissected was 11. 5 ± 2. 2,the postoperative chest cavity drainage was( 515. 8 ± 45. 2) ml,the postoperative days of extubation was( 3. 3 ± 0. 5) d,the postoperative hospital stay was( 10. 6 ± 1. 2) d,and the postoperative pain NRS scores were( 2. 3 ± 0. 6) points. There were 6 cases of postoperative pneumonia,2 cases of leakage,1 case of chylothorax,and 2 cases of incision infection,all of which were cured after symptomatic treatment. The postoperative pathology showed 23 cases of squamous cell carcinoma,38 cases of adenocarcinoma,and 5 cases of adenosscale carcinoma. The clinical pathological stages were 28 cases in stageⅠa,20 cases in stage Ⅰb,10 in stage Ⅱa,and 8 in stage Ⅱb. All the 66 cases were followed up for 3-15 months,with an average of 12 months. No recurrence or metastasis occurred. Conclusions Single-incision thoracoscopic lobectomy is safe and f

关 键 词：单一切口胸腔镜 肺叶切除术 非小细胞肺癌 

分 类 号：R734.2[医药卫生—肿瘤]