[1]陈晓春 谢骏** 唐佳 韩松 陆佳昊 周开国.涉肺裂的单孔胸腔镜肺段切除术55例[J].中国微创外科杂志,2023,01(10):753-758.
　Chen Xiaochun,Xie Jun,Tang Jia,et al.Singleport Thoracoscopic Segmentectomy Involving Pulmonary Fissure: Report of 55 Cases[J].Chinese Journal of Minimally Invasive Surgery,2023,01(10):753-758.
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涉肺裂的单孔胸腔镜肺段切除术55例()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2023年10期
页码:
753-758
栏目:
临床研究
出版日期:
2023-10-25

文章信息/Info

Title:
Singleport Thoracoscopic Segmentectomy Involving Pulmonary Fissure: Report of 55 Cases
作者:
陈晓春 谢骏** 唐佳 韩松 陆佳昊 周开国
(苏州科技城医院胸外科，苏州215163)
Author(s):
Chen Xiaochun;  Xie Jun;  Tang Jia;  et al.
Department of Thoracic Surgery, Suzhou Science and Technology Town Hospital, Suzhou 215163, China
关键词:
单孔胸腔镜; 肺段切除术; 肺裂
Keywords:
Singleport thoracoscopy; Segmentectomy; Lung fissure
文献标志码:
A
摘要:
目的总结涉及肺裂处理的单孔胸腔镜肺段切除术的手术经验。方法2018年12月~2022年10月，行涉及肺裂的单孔胸腔镜肺段切除术55例，其中左肺24例，均涉及斜裂；右肺31例，16例涉及斜裂，9例涉及水平裂，6例水平裂和斜裂均涉及。结果55例均顺利完成手术，无中转开胸，未增加辅助切口，未改行扩大肺叶切除术。手术时间(169.6±40.3)min，术中出血量(100.9±94.7)ml。术后胸腔排气管留置时间(3.2±1.7)d，排液管留置时间(4.9±1.6)d，术后住院时间(7.1±2.0)d。7例浸润性腺癌清扫淋巴结(5.2±2.3)枚，(4.2±0.8)站。并发症6例(10.9%)，包括肺漏气3例、心律失常2例、咯血1例，均治愈。结论单孔胸腔镜手术可以处理几乎所有的涉肺裂肺段手术，可以保证足够的切缘距离，完全处理肺裂有利于血管的暴露和放置手术器械，降低手术难度，使手术安全、流畅，是必要的手术流程。
Abstract:
ObjectiveTo summarize surgical experience of singleport videoassisted thoracoscopic segmentectomy involving the treatment of pulmonary fissure.MethodsFrom December 2018 to October 2022, 55 patients underwent singleport thoracoscopic segmentectomy involving pulmonary fissure, including 24 leftsided cases involving the oblique cleft and 31 rightsided cases consisting of 16 involving oblique fissure, 9 involving horizontal fissure, and 6 involving both horizontal and oblique fissure.ResultsAll the 55 patients underwent singleport videoassisted thoracoscopic segmentectomy successfully. There was no need of conversion to thoracotomy, additional auxiliary surgical incision, or conversion to extended lobectomy. The average operation time was (169.6±40.3) min, the average intraoperative blood loss was (100.9±94.7) ml, the average postoperative chest exhaust tube indwelling time was (3.2±1.7) d, the average postoperative chest drainage tube indwelling time was (4.9±1.6) d, and the average postoperative hospital stay was (7.1±2.0) d. Of the 7 cases of invasive adenocarcinoma (IAC), the mean number of harvested lymph nodes was (5.2±2.3), and the mean number of harvested lymph node stations was (4.2±0.8). Complications occurred in 6 cases (10.9%), including 3 cases of pulmonary leakage, 2 cases of arrhythmia, and 1 case of hemoptysis, all of which were cured.ConclusionsSingleport videoassisted thoracoscopic segmentectomy can handle almost all the surgery involving the lung fissures, which can ensure sufficient margin distance. Complete treatment of fissures is beneficial to the exposure of blood vessels and the placement of surgical instruments, which reduces the difficulty of the operation and makes the operation safe and smooth, being a necessary surgical process.

参考文献/References:

[1]Saji H,Okada M,Tsuboi M,et al.Segmentectomy versus lobectomy in smallsized peripheral nonsmallcell lung cancer (JCOG0802/WJOG4607L):a multicentre,openlabel,phase 3,randomised,controlled,noninferiority trial.Lancet,2022,399(10335):1607-1617.
[2]王君,张天赐,魏大中.单孔胸腔镜肺段切除术治疗肺结节118例.中国微创外科杂志,2020,20(11):991-994．
[3]朱征,张明,王勇,等.单孔全胸腔镜解剖性肺段切除术治疗早期非小细胞肺癌.中国微创外科杂志,2019,19(10):887-892.
[4]Altorki N,Wang X,Kozono D,et al.Lobar or sublobar resection for peripheral stage IA nonsmallcell lung cancer.N Engl J Med,2023,388(6):489-498.
[5]北京医学会胸外科分会，中国医疗保健国际交流促进会胸外科分会.基于高分辨CT影像学指导≤2 cm磨玻璃结节肺癌手术方式胸外科专家共识(2019版).中国胸心血管外科临床杂志,2020,27(4):395-400.
[6]陆佳昊,谢骏,唐佳,等.单孔胸腔镜复杂肺段切除术在直径≤2 cm磨玻璃结节中的应用.中国微创外科杂志,2023,23(2):103-107.
[7]詹必成,刘建,陈剑,等.三维重建引导下胸腔镜扩大肺亚段切除术治疗肺段边缘结节.中国微创外科杂志,2021,21(10):904-907.
[8]查鹏,梁正.胸腔镜肺段切除术治疗磨玻璃结节的研究进展.中国微创外科杂志,2020,20(9):843-847.
[9]Batchelor TJP,Ljungqvist O.A surgical perspective of ERAS guidelines in thoracic surgery.Curr Opin Anaesthesiol,2019,32(1):17-22.
[10]Schuchert MJ,Pettiford BL,Keeley S,et al.Anatomic segmentectomy in the treatment of stage I nonsmall cell lung cancer.Ann Thorac Surg,2007,84(3):926-932.
[11]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.
[12]Lewis RJ,Caccavale RJ,Sisler GE,et al.One hundred consecutive patients undergoing videoassisted thoracic operations.Ann Thorac Surg,1992,54:421-426.
[13]Takahashi N,Sawabata N,Kawamura M,et al.Optimal sublobar resection for cstage I nonsmall cell lung cancer: significance of margin distance to tumor size ratio and margincytology (supplementary analysis of KLSG0801):complete republication.Gen Thorac Cardiovasc Surg,2019,67(8):690-696.
[14]孙超,陆世春,王霄霖,等.三维重建技术在胸腔镜解剖性肺段切除术中的应用.中国微创外科杂志,2019,19(2):115-117.
[15]Schieman C,MacGregor JH,Kelly E,et al.Can preoperative computed tomography of the chest predict completeness of the major pulmonary fissure at surgery?Can J Surg,2011,54(4):252-256.

备注/Memo

备注/Memo:
基金项目：基础研究计划(自然科学)-面上项目(BK20201183)**通讯作者，Email：xie9645216@163.com
更新日期/Last Update: 2024-01-08