优先支气管成形在单孔胸腔镜肺上叶切除术中应用的单中心回顾性分析  

Clinical application of preferential manual bronchoplasty in single-port video-assisted thoracoscopic upper lobectomy:A retrospective analysis in a single center

作　　者：齐康 林钢[1] 张西宁 刘海波[1] 黄伟明[1] 刘敬伟[1] 李简[1] QI Kang;LIN Gang;ZHANG Xining;LIU Haibo;HUANG Weiming;LIU Jingwei;LI Jian(Department of Thoracic Surgery,Peking University First Hospital,Beijing,100034,P.R.China)

机构地区：[1]北京大学第一医院胸外科,北京100034

出　　处：《中国胸心血管外科临床杂志》2023年第10期1422-1428,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：北京大学第一医院种子基金(2018SF078)。

摘　　要：目的探讨优先支气管成形单孔胸腔镜肺上叶切除术的安全性及可行性。方法回顾性分析2020年3月—2022年3月在北京大学第一医院胸外科行单孔胸腔镜肺上叶切除术的457例非小细胞肺癌患者的临床资料。按手术方式将入组患者分为优先支气管成形组和传统单孔胸腔镜组,并通过1∶1进行倾向性评分匹配。结果共纳入204例患者,每组各102例。优先支气管成形组男50例、女52例,平均年龄(62.2±10.1)岁;传统单孔胸腔镜组男49例、女53例,平均年龄(61.2±10.7)岁。优先支气管成形组左肺上叶切除手术时间更短[(154.4±37.0)min vs.(221.2±68.9)min,P<0.01],出血量更少[(66.5±116.9)mL vs.(288.6±754.5)mL,P=0.02],淋巴结清扫数量更多[(19.8±7.5)枚vs.(15.2±4.7)枚,P<0.01],术中转为多孔或开放手术的发生率更低(2.3%vs.13.8%,P=0.04)。在右肺上叶切除术中,优先支气管成形组和传统单孔胸腔镜组的术后结果差异无统计学意义(P>0.05)。两组均无围手术期死亡和支气管胸膜瘘发生。结论相比传统单孔胸腔镜肺上叶切除术,优先支气管成形除具有相似的安全性和可行性外,其在左肺上叶切除术中具有手术时间更短、出血量更少、淋巴结清扫数量更多、转为开放或多孔手术发生率更低的优势。Objective To explore the safety and feasibility of preferential manual bronchoplasty in single-port video-assisted thoracoscopic surgery(VATS)upper lobectomy.Methods The clinical data of 457 patients with nonsmall cell lung cancer who underwent single-port VATS lobectomy in the Department of Thoracic Surgery of Peking University First Hospital from March 2020 to March 2022 were retrospectively analyzed.The patients were divided into a preferential manual bronchoplasty group and a traditional single-port VATS lobectomy group with a 1:1 propensity score matching for further research.Results A total of 204 patients were matched,and there were 102 patients in each group.There were 50 males and 52 females aged 62.2±10.1 years in the preferential bronchoplasty group,and 49 males and 53 females aged 61.2±10.7 years in the traditional single-port VATS group.The preferential bronchoplasty group had shorter surgical time(154.4±37.0 min vs.221.2±68.9 min,P<0.01),less bleeding(66.5±116.9 mL vs.288.6±754.5 mL,P=0.02),more lymph node dissection(19.8±7.5 vs.15.2±4.7,P<0.01),and a lower conversion rate to multi-port or open surgery(2.3%vs.13.8%,P=0.04)in left upper lobe resection.In the right upper lobe resection surgery,there was no statistical difference in postoperative results between two groups.There was no perioperative death or occurrence of bronchopleural fistula in both groups.Conclusion Compared with traditional single-port VATS upper lobectomy,preferential bronchoplasty has similar safety and feasibility.In addition,priority bronchoplasty in left upper lobectomy has the advantages of shorter surgical time,less bleeding,more lymph node dissection,and lower conversion rate to multiport or open surgery.

关 键 词：非小细胞肺癌 肺上叶 单孔胸腔镜手术 支气管成形 

分 类 号：R734.2[医药卫生—肿瘤]