胸腔镜肺联合亚段切除术76例的单中心回顾性研究  

Thoracoscopic combined subsegmentectomy for 76 patients:A retrospective study in a single center

作　　者：詹必成 刘建[1] 陈剑[1] 刘永志[1] 李根水 郭昆亮 王啸[1] 熊焱正 古明博 ZHAN Bicheng;LIU Jian;CHEN Jian;LIU Yongzhi;LI Genshui;GUO Kunliang;WANG Xiao;XIONG Yanzheng;GU Mingbo(Department of Cardiothoracic Surgery,Anqing Municipal Hospital,Anqing Medical Center of Anhui Medical University,Anqing,246003,Anhui,P.R.China)

机构地区：[1]安徽医科大学安庆医学中心、安庆市立医院心胸外科,安徽安庆246003

出　　处：《中国胸心血管外科临床杂志》2023年第1期47-51,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：安徽医科大学临床科学基金项目(2020xkj240)。

摘　　要：目的总结胸腔镜肺联合亚段切除术(combined subsegmentectomy,CSS)的临床应用经验。方法回顾性分析2018年5月—2022年7月安庆市立医院行胸腔镜CSS 76例患者的临床资料,其中男22例、女54例,年龄27.0~76.0(54.3±10.5)岁。所有患者术前行胸部薄层CT扫描、血管支气管三维重建。采用改良膨胀-萎陷法或荧光胸腔镜系统显示段间平面。结果76例手术共切除肺结节86枚,1例左上肺S^(1+2)c+S^(4)a,1例右上肺S2b+S^(3)a,1例右上肺S1b+S^(3)b,均因切缘不足,进一步行肺叶切除;1例左上肺S^(1+2)+S^(3)a,因残留肺不张,进一步行左上肺固有段切除;1例左上肺S^(1+2)c+S^(3)a,因B3b+c损伤,进一步行左上肺固有段切除,其余均按规划完成手术。全组手术时间90.0~350.0(174.9±53.2)min,术中出血量50.0(20.0,50.0)mL,术后住院时间6.0(5.0,7.0)d。术后肺部感染9例,咯血3例,肺漏气时间>3 d 4例,气胸1例,胸腔积液1例,心肌梗死1例,均治愈后出院,无围手术期死亡。结论胸腔镜CSS相对复杂,术前三维重建规划、术中精细操作,技术上安全可行。Objective To summarize the clinical experience of thoracoscopic combined subsegmentectomy(CSS).Methods The clinical data of 76 patients who underwent thoracoscopic CSS in Anqing Municipal Hospital from May 2018 to July 2022 were retrospectively analyzed,including 22 males and 54 females,aged 27.0-76.0(54.3±10.5)years.All patients underwent preoperative three-dimensional computed tomography bronchography and angiography using dual source CT.The modified inflation-deflation technique or indocyanine green was used to identify the intersubsegmental border.Results A total of 86 pulmonary nodules were resected in 76 patients.One patient of left upper lobe S^(1+2)c+S^(4)a,1 patient of right upper lobe S~2b+S^(3)a and 1 patient of right upper lobe S~1b+S^(3)b were further performed lobectomy due to insufficient margin.One patient of left upper lobe S^(1+2)+S^(3)a was further performed left upper division segmentectomy due to residual atelectasis.One patient of left upper lobe S^(1+2)c+S^(3)a was further performed left upper division segmentectomy due to B~3b+c injury,and the rest completed planned surgeries successfully.The operative time was 90.0-350.0(174.9±53.2)min.The operative hemorrhage volume was 50.0(20.0,50.0)mL.The postoperative hospital stay time was 6.0(5.0,7.0)d.Postoperative complications included pulmonary infection in 9 patients,hemoptysis in 3 patients,persistent pulmonary leakage>3 d in 4 patients,pneumothorax in 1 patient,pleural effusion in 1 patient,and myocardial infarction in 1 patient.All of the patients were cured and discharged without perioperative death.Conclusion Thoracoscopic CSS is relatively complex.Preoperative planning under three-dimensional reconstruction and intraoperative fine operation are helpful for safe completion.

关 键 词：胸腔镜 微创 联合亚段切除术 

分 类 号：R734.2[医药卫生—肿瘤]