单孔胸腔镜在肺部疾病中的临床应用

发布时间：2018-03-25 21:20

本文选题：单孔胸腔镜　切入点：肺叶切除　出处：《安徽医科大学》2017年硕士论文

【摘要】：目的:探讨单孔胸腔镜手术(Uniportal video-assisted thoracoscopic surgery,Uniportal VATS)在治疗肺部疾病中的可行性及安全性,为其在临床上的推广使用提供依据。方法:收集我科于2015年1月至2016年2月采用单孔胸腔镜手术治疗肺部疾病的病例,统计分析全组单孔VATS的手术时间、术中出血、术后留置胸管时间、术后住院时间、术后并发症等围手术期临床指标,并且对所有患者进行定期术后随访。结果:全组共开展了69例单孔腔镜手术,病种包括非小细胞肺癌、自发性气胸、肺隔离症、支气管扩张等8种疾病。按手术方式分为2种,行肺叶切除29例,肺局部切除40例;肺局部切除包括肺大泡切除及肺楔形切除,肺大泡切除28例,肺楔形切除12例。行肺叶切除29例,肺叶切除手术时间170±32min,术中出血205±145ml,术后留置胸管3.7±2.1天,平均术后住院8.3±3.1天,术中1例在游离动脉鞘时因为门钉淋巴结粘连紧密而造成动脉壁破裂出血而被迫中转开胸,其余行肺叶切除手术均未中转,肺叶切除中转率1/29(3.4%),行肺叶切除术后8例合并胸腔积液需再次处理。肺局部切除共40例,平均手术时间64±32min,术中出血68±23ml,腔引流管留置时间3.0±1.9天,术后住院时间5.7±1.8天,肺局部切除40例均未中转,1例行肺大泡切除患者术后出现持续性漏气,经保守治疗后痊愈,其他患者恢复顺利。全组无其他严重并发症及围手术死亡,随访3~12月均恢复良好,全组患者恢复良好,气胸患者无复发。结论:通过对我科单孔VATS手术的统计,可以发现单孔胸腔镜在治疗肺部疾病中是安全可行的,全组69例手术中,仅1例发生中转,其余手术均能在单孔下顺利完成。就病种而言,全组包括8种肺部疾病,有肺良性疾病,也有肺部恶性肿瘤,均能在单孔下完成操作,因此单孔VATS在多种肺部疾病中均可以得到使用。就手术方式而言,主要包括两种,相对简单的肺局部切除未有中转,取得效果满意;而相对复杂的肺叶切除,也能在单孔下顺利完成,因此单孔VATS可开展的手术方式可多种多样。就我们经验而言,单孔VATS手术操作较传统腔镜技术(conventional video-assisted thoracoscopic surgery,c-VATS)对术者的要求更高。因此需要通过一定的学习,才能完全掌握,学习过程中应先易后难,应先掌握相对较简单的手术方式,再尝试相对复杂的,能够提高手术的安全性。如果术者在掌握一定的传统胸腔镜技术之上,掌握单孔腔镜技术将变得更加容易。就手术效果而言,单孔VATS手术效果满意,全组患者在围手术期及术后随访中均未出现较严重并发症,而且较c-VATS创伤更小、术后疼痛更轻、更加美观,是一种更加微创的手术方式。因此单孔VATS值得在临床上推广。
[Abstract]:Objective: to investigate the feasibility and safety of single hole thoracoscopic surgery (video-assisted thoracoscopic Surgeryus Uniportal VATS) in the treatment of pulmonary diseases. Methods: from January 2015 to February 2016, we collected the patients who were treated with single hole thoracoscopic surgery for pulmonary diseases, and analyzed the operative time and intraoperative bleeding of the whole group of single hole VATS. All the patients were followed up regularly. Results: 69 cases of single hole endoscopic surgery were performed in the whole group, including non-small cell lung cancer (NSCLC). Spontaneous pneumothorax, pulmonary sequestration, bronchiectasis and other 8 kinds of diseases. According to the operation method, there are 2 kinds of diseases. There are 29 cases of lobectomy, 40 cases of local resection of lung, 28 cases of pneumonectomy including alveolar resection and wedge resection of lung, 28 cases of alveolar resection. Pulmonary wedge resection was performed in 29 cases. The operative time of lobectomy was 170 卤32 min, the intraoperative bleeding was 205 卤145 ml, the mean hospitalization was 8.3 卤3.1 days, and the postoperative indwelling chest tube was 3.7 卤2.1 days. One case was forced to open chest because of the close adhesion of portal nail lymph nodes during the free arterial sheath, and the others underwent lobectomy. The conversion rate of lobectomy was 1 / 29 ~ 3.4%, and 8 cases with pleural effusion after lobectomy needed to be retreated. The average operative time was 64 卤32 min, the average operative time was 64 卤32 min, the intraoperative bleeding was 68 卤23 ml, the retention time of drainage tube was 3.0 卤1.9 days, and the postoperative hospitalization time was 5.7 卤1.8 days. In all 40 cases of local pneumonectomy, 1 patient with pulmonary alveolectomy had sustained air leakage, recovered after conservative treatment, and the other patients recovered smoothly. There were no other serious complications and perioperative death in the whole group. All the patients were followed up for 3 to 12 months. Conclusion: through the statistics of single hole VATS operation in our department, we can find that single hole thoracoscopy is safe and feasible in the treatment of pulmonary diseases. The rest of the operations can be performed successfully under a single hole. As far as diseases are concerned, the whole group includes 8 kinds of lung diseases, including benign lung diseases and malignant lung tumors, all of which can be performed under a single hole. So the single hole VATS can be used in many kinds of lung diseases. As far as the operation method is concerned, there are mainly two kinds of operation, the relatively simple local resection of the lung has not been transferred, and the result is satisfactory, while the relatively complicated lobectomy, The single hole VATS can be performed in a variety of ways. In our experience, the single hole VATS procedure is more demanding than the conventional video-assisted thoracoscopic surgery-c-VATS (conventional video-assisted thoracoscopic Surgery-c-VATS). In order to fully master, the learning process should be easier than before, should first master a relatively simple operation, and then try a relatively complex, can improve the safety of the operation, if the operator is in the possession of certain traditional thoracoscopic technology, It will be easier to master the technique of single hole endoscopy. In terms of the effect of single hole VATS, there are no serious complications, less trauma and less postoperative pain in the whole group during perioperative period and postoperative follow-up. More beautiful, is a more minimally invasive operation, so single-hole VATS is worthy of clinical promotion.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R655.3

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