剑突下单孔胸腔镜手术中特殊情况的处理对策  

Summary and treatment of special situations in subxiphoid uniportal VATS surgery

作　　者：瞿冀琛[1] 黄鑫 赵德平[1] 陈健 姜格宁[1] 蒋雷[1] Qu Jichen;Huang Xin;Zhao Deping;Chen Jian;Jiang Gening;Jiang Lei(Department of Thoracic Surgery,Shanghai Pulmonary Hospital,Tongji University,Shanghai 200433,China)

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》2019年第11期659-663,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨剑突下单孔VATS手术中特殊情况的处理对策。方法回顾性收集2014年9月至2018年5月行剑突下VATS肺段切除手术的患者资料,剑突下单孔肺段切除242例,男76例(31.40%),女166例(68.60%);年龄(56.77±10.42)岁;吸烟史20例(12.55%),FEV10.94±0.15。所有病例术前均行心肺功能、胸部和全身相关检查,未见远处转移病灶。剑突下单孔VATS纵隔肿瘤切除22例,同期双侧手术75例。术中心脏骤停1例,心包压塞1例,无名静脉损伤出血2例。此外,术中亦出现心律失常、肺段平面定位困难、小结节定位困难、剑突下器械互相干扰和扶镜体位等问题。结果剑突下肺段切除手术时间(2.14±0.78)h,术中出血量(93.33±91.27)ml,淋巴结取样组数4.00±1.00,取样淋巴结(10.64±3.38)个,胸腔引流量(260.94±162.38)ml,术后住院(4.67±9.54)天。剑突下肺段切除术后并发症主要包括剖胸止血1例、术后持续漏气6例、肺部血肿2例、心律失常9例。患者无围手术期死亡。17例因术中严重心律失常、心脏问题、术中出血等特殊情况,改变手术方式。结论剑突下VATS手术是胸部微创技术进步的重要表现,选择合适病例且在熟练掌握剑突下胸腔镜技术、运用特殊手术技巧的前提下才是安全、可行的。Objective To explore the special situation in subxiphoid uniportal VATS surgery and summarize the treatment strategies.Methods In September 2014,the subxiphoid uniportal VATS surgery was carried out.Up to now,our research team has completed more than 300 subxiphoid uniportal VATS operations,especially including 242 cases of subxiphoid uniportal VATS segmentectomy and 22 cases of subxiphoid uniportal VATS mediastinal tumor resection.Some special situations were encountered during the operation,including cardiac arrest,pericardial tamponade,innominate venous injury,severe arrhythmia,difficulty in positioning the lung segment,and difficulty in positioning the small nodule et al.Results Some patients changed the surgical procedure during surgery due to intraoperative emergencies such as severe arrhythmia,heart problems,intraoperative bleeding.Postoperative complications mainly included thoracotomy and hemostasis,continuous air leak after operation,pulmonary hematoma,arrhythmia,and no perioperative death.Conclusion Under the subxiphoid uniportal VATS surgery is an important manifestation of the minimally invasive technique of the chest.It is safe and feasible to select suitable cases,master the thoracoscopic technique and special surgical techniques.Special situations during subxiphoid uniportal VATS surgery should be known.

关 键 词：胸腔镜手术 单孔 剑突下 手术并发症 

分 类 号：R65[医药卫生—外科学]