非小细胞肺癌手术单孔胸腔镜淋巴结清除术应用研究  

Clinical application of single-port thoracoscopic non-grasping whole lymph node dissection technique in lung cancer surgery

作　　者：任占良 张泳 任小朋 韩英杰 张卫峰 刘云昊 REN Zhan-liang;ZHANG Yong;REN Xiao-peng;HAN Ying-jie;ZHANG Wei-feng;LIU Yun-hao(Department of Thoracic and Cardiac Surgery,Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xianyang 712000,China)

机构地区：[1]陕西中医药大学附属医院胸心外科,陕西咸阳712000

出　　处：《中华肿瘤防治杂志》2021年第5期365-368,共4页Chinese Journal of Cancer Prevention and Treatment

基　　金：陕西省中医药管理局科研项目(2019-ZZ-LC048);咸阳市科学技术局科学技术研究计划(2018k02-82);咸阳市单孔胸腔镜联合中医治疗肺癌快速康复创新团队研究项目[咸科发(2019)46号]。

摘　　要：目的探讨单孔胸腔镜无抓持整块淋巴结清除术在非小细胞肺癌手术中的临床应用效果。方法回顾分析2017-02-01-2019-04-31陕西中医药大学附属医院胸心外科收治的60例非小细胞肺癌患者临床资料,均在行肺癌根治术中应用单孔胸腔镜联合无抓持淋巴结清除术。观察术中出血量、手术时间、纵隔淋巴结清除个数、疼痛评分和术后并发症等指标。结果所有患者均采用单孔胸腔镜联合无抓持技术完成肿瘤所在肺叶或肺段切除与淋巴结清除术,无中转开胸和增加操作孔,平均手术时间为(90.37±14.28)min,术中出血量(41.58±10.29)mL;平均清除纵隔淋巴结(11.3±2.6)个。术后病理确诊鳞癌17例,腺癌36例,其他类型非小细胞肺癌7例。术后均未服用阿片类镇痛药,d_(1)~d_(3)切口疼痛视觉模拟评分(VAS)分别为3.3±1.1、2.7±0.8和1.5±0.8;术后胸引流量(693.5±135.06)mL,胸引管拔除时间(4.96±2.40)d,住院天数(9.96±2.64)d;切口甲级愈合率100.0%。术后5例出现低热,考虑术后吸收热,给予对症退热治疗后好转;术前4例有较严重的慢性阻塞性肺疾病,术后出现肺部感染,给予抗炎、祛痰雾化对症治疗后治愈出院;1例出现支气管胸膜瘘,给予引流、抗感染治疗后痊愈。其余术后无心律失常、肺不张、淋巴管漏、乳糜胸和食管瘘等并发症。结论单孔胸腔镜联合无抓持淋巴结清除术创伤小,对于减轻患者术后不适和促进早期康复有积极意义,安全可行。Objective To investigate the clinical application of single-port thoracoscopic non-grasping whole lymph node dissection technique in lung cancer surgery.Methods A review of 60 patients with non-small cell lung cancer admitted to the Department of Thoracic and Cardiac Surgery of the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine on February 1,2017 solstice and April 31,2019 was conducted,all of whom underwent radical lung cancer resection with single-port thoracoscopy combined with non-grasping lymph node dissection technique.Intraoperative blood loss,operation time,number of mediastinal lymph node dissection,and pain score were observed.Postoperative complications:pulmonary infection,atelectasis,pleural effusion,chest wall paresthesia.Results All patients used single-port thoracoscopy combined with non-grasping technique to complete the resection of the lung lobe or pulmonary segment where the tumor was located and lymph node dissection,without changing to thoracotomy or increasing operation holes.The average operation time was(90.37±14.28)min,and the intraoperative blood loss was(41.58±10.29)ml.Mediastinal lymph node dissection averaged(11.3±2.6).Postoperative pathology confirmed squamous cell carcinoma in 17 cases,adenocarcinoma in 36 cases,and other non-small cell lung cancer in 7 cases.No opioid analgesics were taken after surgery.Visual analogue scores(VAS)of incision pain in the first 1,2 and 3 dwere 3.3±1.1,2.7±0.8 and 1.5±0.8,respectively.Postoperative chest drainage volume(693.5±135.06),removal time(4.96±2.40)d,length of stay(9.96±2.64)d;Grade a wound healing rate was 100.0%.After the operation,5 cases presented low fever.Considering the postoperative absorption of heat,symptomatic antipyretic therapy improved.Four patients had severe copd before operation and pulmonary infection after operation.They were cured and discharged after symptomatic treatment with anti-inflammatory,expectorant and atomization.One patient developed bronchopleural fistula and recovered after a

关 键 词：单孔胸腔镜 无抓持技术 肺癌 淋巴结清除 

分 类 号：R734.2[医药卫生—肿瘤]