老年肺结节患者胸腔镜肺段切除术的近期效果分析  

Short-term effect of thoracoscopic pulmonary segmentectomy in elderly patients with pulmonary nodules

作　　者：田文鑫[1] 佟宏峰[1] 孙耀光[1] 吴青峻[1] 马超[1] 焦鹏[1] 于瀚博 黄川 TIAN Wen-xin;TONG Hong-feng;SUN Yao-guang(Department of Thoracic Surgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院胸外科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730

出　　处：《腹腔镜外科杂志》2020年第7期520-523,共4页Journal of Laparoscopic Surgery

摘　　要：目的:观察胸腔镜解剖性肺段切除术治疗老年肺结节的近期疗效。方法:选择2017年1月至2019年12月收治的年龄≥65岁行胸腔镜解剖性肺段切除术的85例患者,其中男36例,女49例,平均(72.3±5.3)岁。术中确定靶肺段后游离段门结构,分别游离靶肺段肺动脉、段内静脉、支气管,并离断,尽量保留段间静脉。采用肺膨胀萎陷法或靶肺段支气管充气法确定段间平面。分析患者基本临床资料、围手术期及病理资料等。结果:1例患者因淋巴结与肺动脉、支气管粘连紧密中转开胸,余者均在全胸腔镜下顺利完成手术。右肺肺段切除术48例,左肺肺段切除术37例。手术时间平均(155.5±51.8)min,术中出血量50(5,1600)mL,带管时间平均(4.6±2.9)d,术后平均住院(7.6±3.2)d。74例病理结果为原发肺癌,清扫淋巴结站数平均(4.6±1.7),清扫淋巴结(13.8±9.1)枚。14例(16.5%)患者出现围手术期并发症,肺漏气发生率最高(9例)。无围手术期死亡病例。结论:胸腔镜解剖性肺段切除术是老年肺结节患者的有效治疗手段,通过手术经验的积累及技术的改良,其安全性、可行性均较高。Objective:To observe the short-term effect of thoracoscopic segmentectomy in elderly patients with lung nodule.Methods:From Jan.2017 to Dec.2019,85 patients above 65 years old who underwent thoracoscopic segmentectomy were selected,including 36 males and 49 females.The average age was(72.3±5.3)years.After the target lung segment was confirmed,hilum of segment was dissected carefully.The pulmonary artery,pulmonary vein and bronchus of the target segment were distinguished,dissected and cut off,while intersegmental vein was tried to preserve.The inflation-deflation method or targeted bronchus inflation method was used to confirm the intersegmental plane.Clinical basic,perioperative and pathological data were analyzed.Results:Only one patient was converted to thoracotomy due to extensive adhesion of lymph nodes with pulmonary artery and bronchus.All other thoracoscopic operations were successfully completed.Segmentectomy was performed at right lung in 48 patients,and at left lung in 37 patients.The average operation time was(155.5±51.8)min,the blood loss was 50(5,1600)mL,the chest tube duration was(4.6±2.9)d,and the postoperative hospital stay was(7.6±3.2)d.The stations of dissected lymph nodes in 74 patients of primary lung cancer was(4.6±1.7),and the total number of harvested lymph nodes was(13.8±9.1).14 patients(16.5%)developed complications after surgery,in which the most common one was lung leakage>5 d(n=9).There was no perioperative death.Conclusions:Thoracoscopic segmentectomy is an efficient treatment for elderly patients with lung nodule,it is relatively safe and feasible with surgical experience accumulation and technical improvement.

关 键 词：肺结节 胸腔镜检查 肺段切除术 老年人 

分 类 号：R655.3[医药卫生—外科学]