[1]刘士学,王君*①,徐美清①,等.全胸腔镜下解剖性肺段切除41例临床分析[J].中国微创外科杂志,2016,16(12):1127-1130.
　Liu Shixue*,Wang Jun,Xu Meiqing,et al.Complete Video-assisted Thoracoscopic Anatomic Segmentectomy: Report of 41 Cases[J].Chinese Journal of Minimally Invasive Surgery,2016,16(12):1127-1130.
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全胸腔镜下解剖性肺段切除41例临床分析()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
16
期数:
2016年12期
页码:
1127-1130
栏目:
临床研究
出版日期:
2016-12-20

文章信息/Info

Title:
Complete Video-assisted Thoracoscopic Anatomic Segmentectomy: Report of 41 Cases
作者:
刘士学; 王君*①; 徐美清①; 谢怀顺
安徽省淮南市第一人民医院胸外科，淮南232000
Author(s):
Liu Shixue*;  Wang Jun;  Xu Meiqing;  et al.
*Department of Thoracic Surgery, Huainan First People’s Hospital, Huainan 232000, China
关键词:
电视辅助胸腔镜手术; 解剖; 肺段切除术
Keywords:
Video-assisted thoracoscopic surgery; Anatomy; Segmentectomy
文献标志码:
A
摘要:
目的探讨全胸腔镜下肺段切除术的临床应用价值。方法回顾性分析2013年1月~2016年5月41例全胸腔镜下肺段切除术的临床资料，其中淮南市第一人民医院12例，安徽省立医院29例。三孔法，肺段动脉、静脉使用Hem-o-lok或直线型切割缝合器处理，肺段支气管及段间平面均使用直线型切割缝合器处理。结果41例手术均顺利完成，无中转开胸及辅助小切口。手术时间89~208（121.0±15.5）min，术中出血量80~350（142.7±11.5）ml。21例原发肺癌行肺门纵隔淋巴结清扫，清扫淋巴结7~15（10.9±0.6）枚。无围手术期死亡。二次手术2例（1例术后咯血，1例肺不张）。术后胸腔引流时间5~9（7.8±0.2）d，术后住院时间6~14（9.3±0.4）d。术后病理诊断腺癌16例，鳞癌5例，转移癌3例，支气管扩张8例，炎性假瘤4例，结核球4例，血管畸形1例。对21例原发肺癌术后随访2~35(25.4±8.8)月，无复发、转移。结论全胸腔镜下解剖性肺段切除术安全、可行、有效。
Abstract:
ObjectiveTo evaluate the clinical value of complete video-assisted thoracoscopic surgery (VATS) anatomic segmentectomy.MethodsClinical data of 41 patients with lung diseases who underwent complete VATS segmentectomy in Anhui Provincial Hospital (29 cases) and Huainan First People’s Hospital (12 cases) from January 2013 to May 2016 were retrospectively analyzed. The operation was performed with three-port method. The pulmonary artery and vein of the segment were dealt with Hem-o-lok or linear cutter stapler. The bronchi of the segment and intersegmental plane were dealt with staplers.ResultsAll the 41 patients received complete VATS anatomic segmentectomy successfully without conversion to thoracoctomy or assisted small incision surgery. The operation time was 89-208 min (121.0±15.5 min), and the intraoperative blood loss was 80-350 ml (142.7±11.5 ml). The number of lymph node dissection was 7-15 (10.9±0.6) for 21 patients with lung cancer. There was no perioperative death. There were 2 cases of secondary operation, including 1 case of postoperative hemoptysis and 1 case of postoperative pulmonary atelectasis. Postoperative thoracic drainage time was 5-9 days (7.8±0.2 days), and postoperative hospital stay was 6-14 days (93±0.4 days). All the patients were discharged from hospital uneventfully. The postoperative pathological diagnosis showed adenocarcinoma in 16 cases, squamous cell carcinoma in 5 cases, metastatic carcinoma in 3 cases, bronchiectasis in 8 cases, inflammatory pseudotumor and tuberculoma in 4 respectively, and vascular malformation in 1. Lung cancer patients were followed up for 2-35 months (25.4±8.8 months) without recurrence or metastasis.ConclusionComplete VATS anatomic segmentectomy is safe, feasible and available with satisfying outcomes.

参考文献/References:

[1]蔡海波,李迎新,张士法,等.全胸腔镜解剖性肺段切除术12例报告.中国微创外科杂志,2014,14(2):155-157.
[2]张小龙,刘伦旭.电视胸腔镜肺段切除术治疗早期非小细胞肺癌的研究进展.中国胸心血管外科临床杂志,2012,19(2):177-180.
[3]冯剑雄,陈中书,凌东进,等.全胸腔镜肺段切除术17例临床分析.江西医药，2014,49(4):304-306.
[4]Schuchert MJ,Kilic A,Pennathur A,et al.Oncologic outcomes after surgical resection of subcentimeter non-small cell lung cancer.Ann Thorac Surg,2011，91(6):1681-1687.
[5]张艳娇,高禹舜.胸腔镜手术治疗肺癌的现状及趋势.肿瘤学杂志,2014,20(10):800-801.
[6]吴颖猛,黄伟钊,姜海明.胸腔镜下亚肺叶切除及纵隔淋巴结采样治疗早期非小细胞肺癌.广东医学，2013,34(8):1203-1204.
[7]Nomori H,Mori T,Ikeda K,et al.Segmentectomy for selected T1N0M0 non-small cell lung cancer：a prospective study at a single institute.J Thorac Cardiovasc Surg,2012,144(1):87-93.
[8]Schuchert MJ,Abbas G,Awais O,et al.Anatomic segmentectomy for the solitary pulmonary nodule and early-stage lung cancer.Ann Thorac Surg,2012,93(6):1780-1785.
[9]陈晟,毛伟敏.电视胸腔镜肺段切除术治疗早期非小细胞肺癌的现状.肿瘤学杂志，2013,19(10):754-755.
[10]Schuchert MJ,Awais O,Abbas G,et al.Influence of age and IB status after resection of node-negative non-small cell lung cancer.Ann Thorac Surg,2012,93(3):929-935.
[11]Safety OT. Prognosis of limited surgery for octogenarians with non-small-cell lung cancer.Gen Thorac Cardiovasc Surg,2012,60(2):97-103.
[12]郁松,汤井双.胸腔镜辅助肺段切除术在早期肺癌治疗中的应用.江苏医药,2014,40(18):2221-2222.
[13]潘相龙,陈亮,朱全.103例全胸腔镜解剖性肺段切除近期疗效分析.南京医科大学学报（自然科学版）,2014,34(6):800-804.
[14]陈亮.胸腔镜解剖性肺段切除术用于治疗老年早期肺癌病人.实用老年医学,2013,27(12):980-982.
[15]Misaki N,Chang SS,Igai H,et al.New clinically applicable method for visualizing adjacent lung segments using an infrared thoracoscopy system.J Thorac Cardiovasc Surg,2010,140(4):752-756.
[16]Okada M,Mimura T,Ikegaki J,et al.A novel video-assisted anatomic segmentectomy technique:selective segmental inflation via bronchofiberoptic jet followed by cautery cutting.J Thorac Cardiovasc Surg,2007,133(3):753-758.
[17]麻成方,李绍鹏,李志华,等.全胸腔镜下解剖性肺段切除术在GGO中的应用.临床肺科杂志,2015,20(6):1088-1089.
[18]Sienel W,Stremmel C,Kirschbaum A,et al.Frequency of local recurrence following segmentectomy of stage IA non-small cell lung cancer is influenced by segment localization and width of resection margins-implications for patient selection for segmentectomy.Eur J Cardiothorac Surg,2007,31(3):522-527.
[19]El-Sherif A,Fernando HC,Santos R,et al.Margin and local recurrence after sublobar resection of non-small cell lung cancer.Ann Surg Oncol,2007,14(8):2400-2405.
[20]林宗武,蒋伟,王群,等.胸腔镜解剖性肺段切除术20例临床分析.中国胸心血管外科临床杂志,2012,19(3):270-271.
[21]闻伟,陈亮,朱全全,等.全电视胸腔镜下解剖性肺段切除术26例.中国胸心血管外科临床杂志,2013,20(3):317-319.
[22]Miyasaka Y,Oh S,Takahashi N,et al.Postoperative complications and respiratory function following segmentectomy of the lung-comparison of the methods of making an inter-segmental plane.Int Cardiovasc Thorac Surg,2011,12(3):426-429.

备注/Memo

备注/Memo:
*通讯作者，E-mail：wangjun791221@163.com①（安徽省立医院胸外科，合肥230000）
更新日期/Last Update: 2017-03-09