胸腔镜右上肺叶切除手术流程优化临床实践  

Clinical Practice of Thoracoscopic Surgical Procedure Optimization for Right Upper Lobectomy

作　　者：黄建源[1] 陈文树 潘小杰[1] 陈艺勇 林兴[1] HUANG Jianyuan;CHEN Wenshu;PAN Xiaojie;CHEN Yiyong;LIN Xing(Department of Thoracic Surgery, Fujian Provincial Hospital, Provincial Clinic College ofFujian Medical University, Fuzhou 350001, China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院胸外科,福州350001

出　　处：《福建医科大学学报》2022年第2期154-159,共6页Journal of Fujian Medical University

基　　金：福建省自然科学基金引导性项目(2016Y0012)。

摘　　要：目的探讨一种胸腔镜右上肺叶切除手术(RUL)优化的理论,并总结单中心临床实践经验。方法回顾性分析2019年1月—2021年6月187例胸腔镜RUL的非小细胞肺癌患者的临床资料,提出RUL术中“支气管先行”“血管一并离断”“隧道式分离肺裂”3个核心理论。应用其对术中右上肺门结构的处理顺序及方法、融合肺裂的打开方法进行优化。以施行优化手术方案者为优化组(n=98),施行非优化手术方案者为对照组(n=89),比较两组患者围术期及随访数据差别。结果所有患者均顺利完成胸腔镜手术,无术后严重出血及围术期死亡。优化组较对照组手术时间短[(124.9±49.1)vs(172.1±90.6)min,P<0.001]、出血量少[(45.0±33.8)vs(140.3±90.6)mL,P<0.001]、中转开胸率低(0.0%vs 5.6%,P=0.017)、术后持续肺漏气发生率低(0.0%vs 4.5%,P=0.034),差别有统计学意义。结论以“支气管先行”“血管一并离断”“隧道式分离肺裂”为核心的胸腔镜RUL安全、有效。Objective To introduce a theory of optimal thoracoscopic right upper lobotomy(RUL)and summarize the single-center clinical experience.Methods The 3 theoretical cores of optimal RUL are“bronchus first”“blood vessels severed together”and“tunnel separation of lung fissure”.The clinical data of 187 cases of patients with non-small cell lung cancer who underwent thoracoscopic RUL in our center from January 2019 to June 2021 were reviewed.The patients who underwent optimized surgical plan were selected as the experimental group(n=98),and those who underwent non-optimized plan were selected as the control group(n=89).The differences in perioperative period and follow-up data between the two surgical groups were compared and analyzed.Results All patients successfully completed thoracoscopic surgery without severe postoperative bleeding or perioperative death.Compared with the non-optimized group,the optimized group had shorter operation time[(124.9±49.1)vs(172.1±90.6)min,P<0.001],less blood loss[(45.0±33.8)vs(140.3±90.6)mL,P<0.001],and lower conversion rate of thoracotomy(0.0%vs 5.6%,P=0.017).The incidence of persistent postoperative air leakage was lower(0.0%vs 4.5%,P=0.034).Conclusion The thoracoscopic RUL with“bronchial first”“vascular secession together”and“tunnel separation of fissure”as the core is safe and effective and worthy of clinical application.

关 键 词：胸腔镜手术 肺叶切除术 肺癌 手术优化 

分 类 号：R73[医药卫生—肿瘤]