3D-CTBA指导下单孔胸腔镜精准肺亚段切除术外科临床应用初步结果  

Primary clinical application and initial results of 3D⁃CTBA⁃guided uni⁃portal video⁃assisted thoracoscopic precision pulmonary sub⁃segmentectomy

作　　者：陆军 李宛霖 孔祥龙 徐世东[1] 徐海[1] LU Jun;LI Wan-in;KONG Xiang-ong;XU Shi-dong;XU Hai(Department of Thoracic Surgery,Harbin Medical University Cancer Hospital,Harbin 150081,China)

机构地区：[1]哈尔滨医科大学附属肿瘤医院胸外科,黑龙江哈尔滨150081

出　　处：《哈尔滨医科大学学报》2024年第1期41-46,共6页Journal of Harbin Medical University

摘　　要：目的评估三维计算机断层支气管血管成像(three dimensional computed tomography bronchography and angiography,3D-CTBA)指导下单孔胸腔镜肺亚段切除术治疗肺部小结节的安全性和可行性。方法对哈尔滨医科大学附属肿瘤医院胸外科2020年10月~2022年9月完成的30例单孔胸腔镜肺亚段切除术病例进行回顾性分析,包括其围术期临床特点和短期预后。所有患者均在术前行3D-CTBA。结果30例患者均接受了单孔胸腔镜肺亚段切除术,无中转开胸,1例患者因切缘不足改行肺叶切除,1例患者因淋巴结钙化术中失血500 mL,无围术期死亡。平均切缘(27.8±8.0)mm,平均手术时间(203.8±57.5)min,术中失血50 mL(30~500 mL)。术后并发症:延长漏气大于3天者2例,肺炎1例,心律失常2例,肺不张1例。术后病理:原位腺癌1例,微浸润腺癌10例,浸润性非黏液腺癌17例,良性病变2例。平均随访(19.4±7.1)月,30例患者均无复发及转移。结论3D-CTBA指导下单孔胸腔镜肺亚段切除术安全可行,肿瘤学疗效满意,可用于治疗肺部小结节。Objectivee To assess the safety and feasibility of three-dimensional computed tomography bronchography and angiography(3D-CTBA)-guided uni-portal video-assisted thoracoscopic sub-segmentectomy in the treatment of pulmonary small nodules.Methods Data of 30 patients who received uni-portal video-assisted thoracoscopic sub-segmentectomy in Harbin Medical University Cancer Hospital from October 2020 to September 2022 were retrospectively analyzed,including the perioperative clinical characteristics and short term prognosis.3D-CTBA was performed for every patient before surgery.Results All the 30 patients were successfully performed by use of uni-portal video-assisted thoracoscopic sub-segmentectomy without conversion to thoracotomy.One patient was converted to lobectomy due to insufficient safe margin,one patient lost 500 mL of blood intraoperatively due to lymph node calcification;No perioperative mortality occurred.The surgical margin width was(27.8±8.0)mm;The mean operative time was(203.8±57.5)min.The hemorrhage was 50 mL(30~500 mL)。Postoperative complications:Prolonged air leak>3 d in 2 cases,pulmonary infection in 1 case,arrhythmia in 2 cases,and atelectasis in 1 case.Postoperative pathological examinations showed adenocarcinoma in situ(AIS)in 1 patient,microinvasive adenocarcinoma in 10 patients,invasive nonmucinous adenocarcinoma in 17 patients,and benign pulmonary disease in 2 patients.The mean followed up was(19.4±7.1)months,all the 30 patients survived without tumor,no one showed metastasis or recurrence.Conclusion 3D-CTBA-guided uni-portal video-assisted thoracoscopic sub-segmentectomy is a safe and feasible technique with satisfied oncologic results,which can be used in the treatment of pulmonary small nodules.

关 键 词：亚段 肺亚段切除术 单孔胸腔镜 三维重建 肺结节 早期肺癌 

分 类 号：R687.3[医药卫生—骨科学] R734.2[医药卫生—外科学]