三维单孔胸腔镜支气管袖状切除经验  

The initial experience of three-dimensional uniportal video-assisted thoracic surgery for the sleeve resection

作　　者：王奕洋 王喆歆[1] 陈亮 杨海堂[1] 仲晨曦[1] 方文涛[1] 赵珩[1] 姚烽[1] Wang Yiyang;Wang Zhexin;Chen Liang;Yang Haitang;Zhong Chenxi;Fang Wentao;Zhao Heng;Yao Feng(Department of Thoracic Surgery,Shanghai Chest Hospital,Shanghai Jiaotong University,Shanghai 200030,China)

机构地区：[1]上海交通大学附属胸科医院胸外科,200030

出　　处：《中华胸心血管外科杂志》2020年第9期528-532,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨三维(3D)单孔胸腔镜下行支气管袖状切除的安全性和可行性。方法回顾性分析2017年6月至2020年5月期间在上海市胸科医院胸外科接受3D单孔胸腔镜支气管袖状切除术的32例中央型肺癌患者(3D单孔胸腔镜组)的临床资料,收集同期行常规胸腔镜支气管袖状切除术的63例患者(常规胸腔镜组)资料,比较两组临床病理特征和围手术期结果。结果两组患者的临床病理特征基本相似。与常规胸腔镜组相比,3D单孔胸腔镜组手术时间显著缩短[(174.19±73.69)min对(212.46±50.02)min,P=0.004]、出血量显著减少[(73.13±42.70)ml对(130.48±133.72)ml,P=0.020]、清扫淋巴结组数显著增加[(7.63±1.59)组对(6.76±1.70)组,P=0.018],差异均有统计学意义。两组在清扫淋巴结数[(16.81±6.03)枚对(16.19±5.67)枚,P=0.623]和清扫阳性淋巴结数[(1.31±1.58)枚对(1.21±1.96)枚,P=0.803]方面差异均无统计学意义。两组均无围手术期死亡。与常规胸腔镜组相比,3D单孔胸腔镜组中转开胸比例明显低(0对36.5%,P=0.000),胸腔引流管留置时间显著缩短[(4.88±1.15)天对(6.81±3.8)天,P=0.007],术后并发症发生率显著降低(25.0%对47.6%,P=0.046)。另外,3D单孔胸腔镜组开展复杂疑难的袖状切除手术更多,包括肺动脉成形(25.0%对6.3%,P=0.024)、隆凸成形(12.5%对1.6%,P=0.043)等。结论3D单孔胸腔镜支气管袖状切除术是一种安全、可行的手术方式。Objective To discuss the safety and feasibility for the use of 3D uniportal VATS sleeve resection.Methods Totally 32 patients with central lung cancer received 3D uniportal VATS sleeve resection(group A)from June 2017 to May 2020 at Shanghai Chest Hospital.Meanwhile,63 patients received conventional VATS sleeve resection(group B).The clinicopathological and perioperative outcome data were retrospectively collected and analyzed.Results The baseline clinicopathological characteristics between these two groups were statistically similar.Compared with group B,the mean operative time[(174.19±73.69)min vs.(212.46±50.02)min,P=0.004]and blood loss[(73.13±42.70)ml vs.(130.48±133.72)ml,P=0.020]of group A were decreased,harvested lymph node stations was increased(7.63±1.59 vs.6.76±1.70,P=0.018).Lymph nodes dissected showed no statistical difference(1.31±1.58 vs 1.21±1.96,P=0.803).There was no intraoperative death in both groups.Inspiringly,group A possessed lower rate of conversion to thoracotomy(0 vs.36.5%,P=0.000),shorter chest drainage durations[(4.88±1.15)days vs.(6.81±3.8)days,P=0.007].Although there were no deaths during hospitalization in both groups,the incidence of postoperative complications in group A was significantly lower than that in group B(25.0%vs.47.6%,P=0.046).It also presented more complicated operations including pulmonary artery plasty(25.0%vs.6.3%,P=0.024)and carina plasty(12.5%vs.1.6%,P=0.005)against group B.Conclusion 3D uniportal VATS was a safe and feasible technique for the surgical treatment of central lung cancer when conducting a thoracoscopic sleeve resection.

关 键 词：三维 单孔 电视辅助胸腔镜手术 袖状切除 

分 类 号：R734.2[医药卫生—肿瘤]