胸腔镜下主支气管成形术治疗中央型肺癌临床观察  

Thoracoscopic bronchoplasty for central lung cancer

作　　者：徐磊 胡帅 贾向波 姚文健 张全 李基伟 马泽恒 魏立 XU Lei;HU Shuai;JIA Xiang-bo;YAO Wen-jian;ZHANG Quan;LI Ji-wei;MA Ze-heng;WEI Li(Department of Thoracic Surgery,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Research Center for Precision Treatment of Pulmonary Nodules of Henan Province,Research Center for Advanced-stage Pulmonary Disease Surgical Treatment of Henan Province,Research Center for Lung Transplant Enhanced Recovery Surgical Treatment Program of Henan Province,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省人民医院胸外科,郑州大学人民医院河南省肺结节精准治疗工程研究中心,河南省终末期肺疾病外科工程研究中心,河南省肺移植快速康复外科治疗工程研究中心,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2021年第12期1207-1211,共5页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的探讨中央型肺癌患者行胸腔镜下隆突重建、支气管袖状肺叶切除术治疗的临床效果。方法3例中央型肺癌患者。例1患者行体外膜肺氧合支持胸腔镜下双侧序贯开胸隆突重建同期行左全肺切除术治疗;例2患者行胸腔镜下右主支气管成形术,同期行右肺中叶支气管袖状肺叶切除术;例3患者行胸腔镜下左肺舌段、下叶支气管袖状肺叶切除术。3例术后均给予常规预防感染等对症治疗。随访3个月,每30 d复查胸部CT、血气分析,观察3例患者生存情况。结果3例患者均在胸腔镜下完成手术。例1患者手术时间330 min,术中出血量310 mL,清扫淋巴结23枚。例2患者手术时间205 min,术中出血量110 mL,清扫淋巴结13枚。例3患者手术时间310 min,术中出血量100 mL,清扫淋巴结17枚。3例患者均无术中大出血及输血事件。例1患者术后左侧引流管夹闭,间断开放,4 d后拔除,术后5 d拔除右侧胸腔引流管,术后10 d行气管镜检查见气管吻合口旁脓苔及气管胸膜瘘(瘘口针孔样大小),气管镜下痰涂片为黄曲霉菌感染,给予伏立康唑抗真菌治疗1周后,复查气管镜下表现为愈合好转后出院,嘱院外继续口服伏立康唑4周。例2患者术后5 d拔除胸腔引流管,术后8 d复查X线胸片无异常后出院。例3患者术后3 d拔除引流管,术后6 d复查X线胸片无异常后出院。3例患者随访期间胸部CT、血气分析均未见异常,生存状况良好。结论胸腔镜下行隆突重建、支气管袖状肺叶切除术可有效切除肿瘤组织,扩大淋巴结清扫范围,保护肺功能;行体外膜肺氧合支持可减少术中呼吸衰竭的风险,提高中央型肺癌的手术切除率。Objective To investigate the clinical efficacy of thoracoscopic carinal reconstruction and bronchial sleeve lobectomy on central lung cancer.Methods In 3 patients with central lung cancer,patient 1 received thoracoscopic bilateral sequential carinal reconstruction and left lung resection with extracorporeal membrane oxygenation,patient 2 received thoracoscopic right main bronchoplasty and bronchial sleeve lobectomy of the right middle lobe,and patient 3 underwent thoracoscopic left lung lingual segment and bronchial sleeve lobectomy of the left lower lobe.All patients were given routine anti-infection treatment after operation.All patients were followed up and were rechecked chest CT and blood gas analysis every 30 days.The survival of three patients was observed.Results All three patients completed the operation under thoracoscopy.The operation on patient 1 lasted 330 min,the volume of intraoperative blood loss was 310 mL,and 23 lymph nodes were resected.The operation on patient 2 lasted 205 min,the volume of intraoperative blood loss was 110 mL,and 13 lymph nodes were resected.The operation on patient 3 lasted 310 min,the volume of intraoperative blood loss was 100 mL,and 17 lymph nodes were resected.No intraoperative massive hemorrhage or blood transfusion occurred in three patients.In patient 1,the left drainage tube was clamped and opened intermittently,and it was withdrawn on postoperative day 4,while the right drainage tube was withdrawn on postoperative day 5.Tracheoscopy revealed pus at the anastomosis and bronchopleural fistula on postoperative day 10,which was confirmed as Aspergillus flavus infection by sputum smear under tracheoscopy.He was given one-week antifungal treatment with voriconazole,and was discharged after healing and improvement under tracheoscopy.He was asked to continue oral administration of voriconazole for 4 weeks after discharge.In patient 2,the drainage tube was withdrawn on postoperative day 5,and was discharged after no abnormality was found on chest X-ray on postoperative day 8

关 键 词：中央型肺癌 胸腔镜 主支气管成形术 隆突重建术 支气管袖状肺叶切除术 体外膜肺氧合 

分 类 号：R734.2[医药卫生—肿瘤]