单操作孔胸腔镜前、后亚段联合部分切除术治疗右上肺深部结节6例报告  

Single Utility Port Video-assisted Thoracoscopic S2b+S3a Segmental Resection for Right Upper Pulmonary Deep Nodules:Report of 6 Cases

作　　者：沈宇舟[1] 钱俊 周超[1] 黄平[1] 李文涛[1] Shen Yuzhou;Qian Jun;Zhou Chao(Department of Cardiothoracic Surgery,Shanghai Chest Hospital, Shanghai 200030,China)

机构地区：[1]上海市胸科医院胸外科,上海200030 [2]昆明医科大学附属云南省德宏州人民医院胸外科,芒市678400

出　　处：《中国微创外科杂志》2019年第2期167-169,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：上海市胸科医院科技发展基金(2014YZDC20100)

摘　　要：目的介绍一种单操作孔胸腔镜治疗右上肺前、后亚段交界位置的肺深部结节的方法。方法 2016年10月～2017年2月收治右上肺前、后亚段交界位置的肺深部结节6例,直径9～12 mm,平均11 mm,实施单操作孔胸腔镜手术,全胸腔镜下完成前、后亚段联合部分切除+淋巴结采样。结果 6例均成功实施单操作孔胸腔镜手术,手术时间30～52min,平均41.5 min,术中出血50～100 ml,平均75.0 ml,术后拔管时间2～4 d,拔管当天出院,无严重并发症及死亡。病理诊断原位腺癌4例,微浸润性腺癌2例,均无淋巴结转移,TNM分期,ⅠA1期2例,ⅠA2期4例。术后随访6～10个月,平均7.8月,未发现转移。术前FEV1(2.02±0.40) L,术后3个月降至(1.87±0.37) L(与术前的配对t检验,t=6.167,P=0.002),术后6个月回升至(2.03±0.41) L(与术前的配对t检验,t=0.307,P=0.771)。结论对右上肺前、后亚段交界位置的肺深部结节,采用单操作孔胸腔镜进行以病灶为中心的肺亚段切除安全、可行,很好地保护了术后肺功能。Objective To introduce a safe,feasible and practical method of S2b + S3a segmental resection for the treatment of right upper pulmonary deep nodules.Methods From October 2016 to February 2017,we treated 6 cases of solitary pulmonary deep nodule,9 - 12 mm in diameter ( mean,11 mm),with single utility port video-assisted thoracoscopic surgery excision of the S2b + S3a segmental resection and mediastinal lymph node sampling.Results All the 6 cases underwent this operation smoothly.The operative time was 30 - 52 min ( mean,41.5 min),and the intraoperative bleeding was 50 - 100 ml ( mean,75.0 ml).The chest tube drainage duration 2 - 4 days,and the patients were discharged from hospital on the day of extubation.No severe complications or mortality were observed during perioperative period.There were 4 cases of adenocarcioma in situ and 2 cases of micro invasive adenocarcioma,none of the patients having lymph node metastasis.According to the TNM classification,2 cases were stage ⅠA1 and 4 cases were stage ⅠA2.All the patients were followed up for 6 - 10 months postoperatively ( mean,7.8 months) without metastasis.The preoperative FEV1 was ( 2.02 ± 0.40) L,which was decreased to ( 1.87 ± 0.37) L at 3 postoperative months ( t = 6.167,P = 0.002) and to ( 2.03 ± 0.41) L at the 6 postoperative months ( t = 0.307,P = 0.771).Conclusion This method of S2b + S3a segmental resection is safe and feasible to treat the right upper pulmonary deep nodules.

关 键 词：肺深部结节 纯磨玻璃结节 

分 类 号：R734.2[医药卫生—肿瘤]