同期双侧胸腔镜手术在双肺多发肺结节外科治疗中的应用价值  

Feasibility and safety of one-stage bilateral video-assisted thoracic surgery for resection of bilateral multiple pulmonary nodules

作　　者：张书新[1] 赵亚超 周爱国 刘慧峰[1] 郑梦利[1] ZHANG Shuxin;ZHAO Yachao;ZHOU Aiguo;LIU Huifeng;ZHENG Mengli(Department of Thoracic Surgery,Senior Department of Respiratory and Critical Care Medicine,Eighth Medical Center of PLA General Hos-pital,Beijing 100091,China)

机构地区：[1]解放军总医院第八医学中心呼吸与危重症医学部胸外科,北京100091

出　　处：《南方医科大学学报》2023年第7期1254-1258,共5页Journal of Southern Medical University

基　　金：军委后勤保障部保健专项科研课题(22BJZ40)。

摘　　要：目的探讨同期双侧胸腔镜手术(VATS)治疗双肺多发肺结节的可行性和安全性。方法选取2011年7月~2021年8月在我科行同期双侧VATS治疗的双肺多发肺结节患者41例,分析其临床特征、病理学特征以及围手术期结局,并定期随访。结果本组41例患者行双侧VATS手术,其中1例中转开胸,手术方式包括双侧肺叶切除2例(4.9%)、单侧肺叶切除加对侧亚肺叶切除15例(36.6%)和双侧亚肺叶切除24例(58.5%)。手术时间:196.3±54.5 min,失血量:224.6±139.5 mL,胸管留置时间:4.7±1.1 d,住院时间:14±3.8 d。41例患者中有15例为双侧原发性肺癌,21例为单侧原发性肺癌,5例为双侧良性病变;共发现双侧肺部结节112个,其中恶性67个、良性45个。术后出现5例肺部感染、2例呼吸衰竭、2例哮喘发作、2例房颤和1例药物性肝损伤,无围手术期死亡。术后1年生存率为97.6%。结论经过严密的术前评估和精细的围手术期管理,同期双侧胸腔镜手术用于治疗双肺多发肺结节是安全、可行的。Objective To evaluate the feasibility and safety of one-stage bilateral video-assisted thoracic surgery(VATS)for resection of bilateral multiple pulmonary nodules(BMPNs).Methods We analyzed the clinical characteristics,pathological features,perioperative outcomes and follow-up data of 41 patients with BMPNs undergoing one-stage bilateral VATS from July,2011 to August,2021.Results One-stage bilateral VATS was performed uneventfully in 40 of the patients,and conversion to open surgery occurred in 1 case.The surgical approaches included bilateral lobectomy(4.9%),lobar-sublobar resection(36.6%)and sublobar-sublobar resection(58.5%)with a mean operative time of 196.3±54.5 min,a mean blood loss of 224.6±139.5 mL,a mean thoracic drainage duration of 4.7±1.1 days and a mean hospital stay of 14±3.8 days.Pathological examination revealed bilateral primary lung cancer in 15 cases,unilateral primary lung cancer in 21 cases and bilateral benign lesions in 5 cases.A total of 112 pulmonary nodules were resected,including 67 malignant and 45 benign lesions.Postoperative complications included pulmonary infection(5 cases),respiratory failure(2 cases),asthma attack(2 cases),atrial fibrillation(2 cases),and drug-induced liver injury(1 case).No perioperative death occurred in these patients,who had a 1-year survival rate of 97.6%.Conclusion With appropriate preoperative screening and perioperative management,one-stage bilateral VATS is feasible and safe for resection of BMPNs.

关 键 词：胸腔镜手术 同期双侧胸腔镜手术 肺癌 双肺多发肺结节 

分 类 号：R734.2[医药卫生—肿瘤]