单孔胸腔镜后入路右肺中叶切除术52例前瞻性队列研究  

Uniportal thoracoscopic right middle lobectomy via posterior approach in 52 patients:A prospective cohort study

作　　者：颜秀岌 张含露[1] 陈龙奇[1] 顾一敏 王文凭[1] YAN Xiuji;ZHANG Hanlu;CHEN Longqi;GU Yimin;WANG Wenping(Department of Thoracic Surgery,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;Department of Plastic and Burns Surgery,West China Hospital,Sichuan University,Chengdu,610041,P.R.China)

机构地区：[1]四川大学华西医院胸外科,成都610041 [2]四川大学华西医院烧伤整形科,成都610041

出　　处：《中国胸心血管外科临床杂志》2024年第9期1281-1287,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：四川省科技厅资助项目(2023YFS0304)。

摘　　要：目的探索改进的单孔胸腔镜右肺中叶切除术式的临床效果。方法经过改进设计,单孔胸腔镜后入路右肺中叶切除术的切口位于肩胛下角下方第6/7肋间隙,术者站于患者背侧。其手术流程遵循“单向式”胸腔镜肺叶手术推进流程,由近至远、由表及里。依次离断下斜裂、右肺中叶静脉、右肺中叶支气管、右肺中叶动脉分支和水平裂,对于术中冰冻病理诊断为肺癌的患者,继续行纵隔及肺门淋巴结清扫。收集患者的基线资料和围术期指标,评估该术式的安全性和可行性。结果共纳入2021年1月—2023年6月四川大学华西医院连续接受该手术方式的52例患者,男20例、女32例,平均年龄(48.0±10.5)岁。无中转开胸、中转多孔胸腔镜病例,无围手术期死亡病例。平均手术时间(68.1±16.8)min,术中平均出血量(16.5±4.9)mL,术后中位胸腔引流管留置时间2(2~22)d,术后中位住院时间3(3~24)d。术后第1、2、3 d的疼痛视觉模拟评分分别为1.5±0.8、1.7±0.4、0.8±0.7。所有患者无术中及术后严重并发症,1例患者出现术后肺部漏气(>5 d),经保守治疗后治愈。结论单孔胸腔镜后入路右肺中叶切除术安全易行,为单孔胸腔镜右肺中叶切除提供了更佳的视野和操作角度,降低了手术难度。Objective To explore the short-term surgical outcomes of the modified surgical procedure for uniportal thoracoscopic right middle lobectomy(RML).Methods In this modified approach,the incision was created at sixth or seventh intercostal space inferior to the subscapular angle.The surgeon stood on the opposite side of the operating table.The surgery was performed by serial division of the anterior oblique fissure,the vein,bronchus,artery,and horizontal fissure following the single-direction strategy.As for patients with malignant lesions,hilar and mediastinal lymph node dissection was performed.Clinical characteristics and early surgical outcomes were collected and analyzed.Results Fifty two patients were included in this study in the Department of Thoracic Surgery,West China Hospital,Sichuan University between January 2021 and June 2023.There were 20 males and 32 females at an average age of 48.0±10.5 years.No conversion or perioperative mortality was occurred.Mean surgical time was 68.1±16.8 min,mean blood loss was 16.5±4.9 mL,median chest tube duration was 2(2-22)d and median postoperative hospital stay was 3(3-24)d.There was no intraoperative or postoperative complication but one patient developed postoperative prolonged air leak(>5 d).Mean postoperative visual-analog scale on postoperative day 1,day 2 and day 3 was 1.5±0.8,1.7±0.4,0.8±0.7,respectively.Conclusion Trans-posterior-approach uniportal thoracoscopic single-direction RML is a safe,feasible,and effective procedure,which provides an appropriate direction and angle for dissection and stapling,solving the challenge of conventional uniportal RML lobectomy.

关 键 词：单孔胸腔镜手术 右肺中叶切除术 手术技术改进 

分 类 号：R655.3[医药卫生—外科学]