单孔胸腔镜双袖式肺叶切除术——上海市肺科医院47例回顾  

Double sleeve uniportal video-assisted thoracoscopic lobectomy-a retrospective study from shanghai pulmonary hospital

作　　者：蔡剑桥 黄靖 蒋雷 Cai Jianqiao;Huang Jing;Jiang Lei(Department of Thoracic Surgery,Tongji University Affiliated Shanghai Pulmonary Hospital,Shanghai 200433,China;Department of Respiratory,Tongji University Affiliated Shanghai Pulmonary Hospital,Shanghai 200433,China)

机构地区：[1]同济大学附属肺科医院胸外科,上海200433 [2]同济大学附属肺科医院呼吸科,上海200433

出　　处：《中华胸部外科电子杂志》2022年第3期144-149,共6页CHINESE JOURNAL OF THORACIC SURGERY：Electronic Edition

基　　金：上海市肺科医院国青培育项目(fkzr2035)。

摘　　要：目的回顾性分析上海市肺科医院单孔胸腔镜双袖式肺叶切除病例,总结手术技术要点,探讨手术效果及推广价值。方法连续纳入2015年6月至2021年1月在上海市肺科医院接受单孔胸腔镜下双袖式肺叶切除手术病例共计47例。术后每6个月对患者进行电话随访。统计分析手术时长、术中出血量、术后第1天引流量、术后住院时间、术后并发症及术后1年和2年的生存率。结果共纳入男41例,女6例,年龄(60.5±8.0)岁,左肺上叶双袖41例(87.2%),右肺上叶及右肺上中叶双袖各3例(6.4%),主要病理类型为鳞癌30例(63.8%)。TNM分期Ⅰ期9例(19.1%),Ⅱ期17例(36.2%),Ⅲ期21例(44.7%)。手术时间(2.7±0.8)h,术中失血量(168.1±160.0)mL,术后住院时间(5.9±2.9)d,无中转开胸病例。中位随访时间为27个月,术后1年总生存率为87.9%,2年总生存率为68.7%。结论单孔胸腔镜双袖式肺叶切除可彻底切除肿瘤和最大限度保留肺功能,同时减少手术创伤。该手术是一项技术难度较大的手术,在腔镜技术成熟的中心是安全、可行的。Objective The cases of double sleeve uniportal thoracoscopic lobectomy in Shanghai Pulmonary Hospital were retrospectively analyzed and the key points of operational technique were summarized,to further discuss and explore the operation effects and application values.Methods A total of 47 patients who underwent double sleeve uniportal thoracoscopic lobectomy in Shanghai Pulmonary Hospital from June 2015 to January 2021 were consecutively enrolled.Patients were followed up remotely by telephone every 6 months post-operation.The operation duration,intraoperative bleeding,drainage volume on the first day after operation,postoperative hospital stay,complications and 1-and 2-year survival rates were recorded and analyzed.Results A total of 41 males and 6 females were enrolled,with an age of(60.5±8.0)years.41(87.2%)cases received left upper lobe double sleeves lobectomy,3(6.4%)cases received right upper lobe double sleeves lobectomy and 3(6.4%)cases received right and middle double sleeves bilobectomy.The main pathological type was squamous cell carcinoma(30,63.8%).There were 9(19.1%),17(36.2%)and 21(44.7%)of patients who had TNM stages of stage Ⅰ,Ⅱ and Ⅲ,respectively.The mean operation duration was(2.7±0.8)h,the mean intraoperative blood loss was(168.1±160.0)mL,and the mean postoperative hospital stay was(5.9±2.9)days.There was no case conversing to thoracotomy.The median followup time was 27 months.The 1-year overall survival rate was 87.9% and the 2-year overall survival rate was 68.7%.Conclusions Double sleeve uniportal thoracoscopic lobectomy can be used to completely remove tumors and preserve lung function to the greatest extent with reduced surgical traumas.This operation is technique-demanding,which is feasible and safe when carried out in thoracic centers with endoscopy proficiency.

关 键 词：单孔胸腔镜 非小细胞肺癌 双袖式肺叶切除术 

分 类 号：R734.2[医药卫生—肿瘤]