[1]马超*,孙耀光,田文鑫,等.单操作孔全胸腔镜左肺上叶切除术246例[J].中国微创外科杂志,2017,17(08):680-687.
　Ma Chao,Sun Yaoguang,Tian Wenxin,et al.Single Utility Port Complete Videoassisted Thoracoscopic Surgery of Left Upper Lobectomy: Report of 246 Cases[J].Chinese Journal of Minimally Invasive Surgery,2017,17(08):680-687.
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单操作孔全胸腔镜左肺上叶切除术246例()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年08期
页码:
680-687
栏目:
临床论著
出版日期:
2017-08-20

文章信息/Info

Title:
Single Utility Port Complete Videoassisted Thoracoscopic Surgery of Left Upper Lobectomy: Report of 246 Cases
作者:
马超*; 孙耀光; 田文鑫; 佟宏峰; 吴青峻; 焦鹏; 于瀚博
北京医院胸外科国家老年医学中心，北京100730
Author(s):
Ma Chao;  Sun Yaoguang;  Tian Wenxin;  et al.
Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
关键词:
全胸腔镜手术; 单操作孔; 肺叶切除
Keywords:
Complete videoassisted thoracoscopic surgery; Single utility port; Lobectomy
文献标志码:
A
摘要:
目的探讨单操作孔全胸腔镜左肺上叶切除术的临床价值。方法2013年9月～2016年6月完成单操作孔全胸腔镜左肺上叶切除手术246例，其中234例肺癌，12例良性病变。采用双腔气管插管全身麻醉，健侧单肺通气。全部操作在胸腔镜下完成。术者和助手均位于患者腹侧，由术者完成全部操作。胸腔镜观察孔选择腋中线第8肋间长1.5 cm，操作孔选择腋前线第4或第5肋间长3～4 cm，以乳突牵开器牵开皮肤和肌肉或者使用切口保护套进行显露。主要解剖结构处理顺序为叶裂、舌段和后段动脉、舌段及上肺静脉、支气管、尖前段动脉。肺癌患者均清扫纵膈淋巴结：4、5、6、7、8、9组。结果3例中转开胸，无围手术期死亡，无术后严重并发症。剔除3例中转开胸，243例手术时间85～195 min，中位手术时间112 min；术中出血30～600 ml，(155±54)ml。234例肺癌淋巴结切除数量14～57枚，（21±6）枚。术后疼痛视觉模拟评分1～9分，（3.5±19）分。术后总引流量350～1850 ml，中位引流量460 ml；术后带胸管时间2～7 d，平均3 d。术后住院5～14 d，(7±2)d。随访至2016年6月，12例良性肿瘤随访1～30个月，中位时间20个月，全部存活；234例肺癌中，失访37例，197例随访1～33个月，中位随访时间19个月，存活95例，死亡102例，死亡患者术后生存时间6～33个月，中位生存时间25个月。结论单操作孔全胸腔镜左肺上叶切除手术具有安全、微创的特点，而且可操作性强。
Abstract:
ObjectiveTo explore the value of single utility port complete videoassisted thoracoscopic surgery of left upper lobectomy.MethodsFrom September 2013 to June 2016, 246 patients (113 males and 133 females), including 234 cases of lung cancers (cTNM staging Ⅰ-Ⅲa) and 12 cases of benign diseases underwent single utility port completely videoassisted thoracoscopic left upper lobectomy. All the procedures were conducted under general anesthesia with double lumen intubation. The thoracoscope was introduced through the 8th intercostal space on the midaxillary line．A 3-4 cm long utility incision was made on the 4th or 5th intercostal space on the anterior axillary line without rib spreading. The surgeon and the assistant stood on the ventral side of patient. The routine operative sequence was fissurae obliqua, lingular segmental artery, posterior segmental artery, lingular segmental vein, upper lobe pulmonary vein, upper lobe bronchus, apical and anterior segmental artery. Anatomic lobectomy was performed with systemic mediastinal lymph node dissection for lung cancer.ResultsAll the procedures were carried out with no case of death or postoperative serious complications. Conversions to thoracotomy were required in 3 cases. Except these converted to thoracotomy, the surgical duration was 85-195 min (median, 112 min), the blood loss was 30-600 ml (mean, 155±54 ml). The number of lymph node resected was 14-57 (mean, 21±6) in 234 cases of lurg cancer. The postoperative pain scale was 1-9 points (mean, 3.5±1.9 points), the postoperative total drainage was 350-1850 ml (median, 460 ml), and the duration with thoracic tube was 2-7 d (mean, 3 d). The duration of postoperative hospital stay was 5-14 d (mean, 7±2 d). Followups were carried out until June 2016. All the 12 cases of benign diseases survived during followups for 1-30 months (median, 20 months). Among the 234 cases of lung cancer, there were 37 cases of lost of followup. Among the remaining 197 cases followed for 1-33 months (median, 19 months), there were 95 alive cases and 102 fatal cases. The postoperative survival time in the fatal cases was 6-33 months (median, 25 months). ConclusionSingle utility port complete videoassisted thoracoscopic surgery of left upper lobectomy is safe,minimally invasive and easily operated.

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备注/Memo

备注/Memo:
*通讯作者，Email：mach9446@hotmail.com
更新日期/Last Update: 2017-11-22