单操作孔全胸腔镜左肺上叶切除术246例

发布时间：2018-06-21 18:43

本文选题：全胸腔镜手术 + 单操作孔　；参考：《中国微创外科杂志》2017年08期

【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112min;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]:Objective to evaluate the clinical value of single-hole thoracoscopic left superior lobectomy. Methods from September 2013 to June 2016, 246 cases of left superior lobectomy with single hole thoracoscopy were performed, including 234 cases of lung cancer and 12 cases of benign lesions. Two-chamber tracheal intubation general anesthesia, contralateral single lung ventilation. All operations are performed under thoracoscope. Both the operator and assistant were located on the ventral side of the patient, and all operations were performed by the operator. The length of the eighth intercostal of the midaxillary line was 1.5 cm under thoracoscopic observation and the 4th or 5th intercostal length of the operative foramen was 3 ~ 4 cm. The papillary retractor was used to retract the skin and muscle or to use the incision protector to expose. The main anatomical structures were divided into lobar fissure, lingual and posterior segmental artery, lingual segment and superior pulmonary vein, bronchus and anterior apical segment artery. Lung cancer patients were dissected mediastinal lymph nodes. Results 3 cases were converted to thoracotomy, no perioperative death and no serious postoperative complications. The operative time was 85 ~ 195 min in 243 cases of conversion to thoracotomy, the median operative time was 112 min, and the number of lymph nodes excision in 1 457 cases of lung cancer was 21 卤6 in 3 cases of lung cancer with intraoperative hemorrhage of 30 ~ 600 ml / L ~ 155 卤54)ml.234. The visual analogue score of postoperative pain was 1 ~ 9 (3.5 卤1.9). The total drainage volume was 350 ~ 1850 ml, the median drainage was 460 ml, and the postoperative time with chest tube was 2 ~ 7 days, with an average of 3 days. The postoperative hospital stay was 5 ~ 14 days and 7 卤2 days. 12 cases of benign tumors were followed up to June 2016 for 1 ~ 30 months with a median time of 20 months. Out of 234 cases of lung cancer, 37 cases were followed up for 1 ~ 33 months, the median follow-up time was 19 months, 95 cases survived and 102 cases died. The postoperative survival time of the dead patients was 6 ~ 33 months and the median survival time was 25 months. Conclusion the single-hole thoracoscopic left superior lobectomy is safe, minimally invasive and operable.
【作者单位】：北京医院胸外科国家老年医学中心;
【分类号】：R655.3

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