3D-CTBA及3D-VATS单操作孔行解剖性肺段切除治疗非小细胞肺癌

发布时间：2018-03-26 07:39

本文选题：D-CT　切入点：支气管血管成像　出处：《中国肺癌杂志》2017年09期

【摘要】：背景与目的中国是肺癌高发地区,其发病率及死亡率在恶性肿瘤中均占首位。目前低剂量CT检查的普及使早期肺癌检出率显著提高,解剖性肺段切除目前广泛应用于Ia期非小细胞肺癌(non-small cell lung cancer,NSCLC)及不能耐受肺叶切除肺癌患者。但因肺段解剖结构及手术操作相对复杂,使得其具有较高的手术风险与难度。我们应用三维计算机断层扫描支气管血管成像(three-dimensional computed tomography bronchography and angiography,3D-CTBA)及三维电视辅助胸部外科技术(three-dimensional video-assisted thoracic surgery,3D-VATS)单操作孔行解剖性肺段切除微创手术技术治疗NSCLC,以探讨其临床效果,为其临床应用提供相关可行性及理论依据。方法回顾性分析苏州大学附属第一人民医院胸外科2015年10月-2017年04月共施行57例术前对肺部病灶予以3D-CTBA重建以及术中应用3D-VATS单操作孔进行解剖性肺段切除治疗NSCLC病例。结果全组均全腔镜下顺利完成,无中转开胸。手术时间平均(142.2±28.3)min,术中出血量平均(93.8±46.5)m L。平均淋巴结清扫数目(9.1±2.2)个,术后胸腔引流量平均(429.8±181.2)m L。术后留置胸管时间(2.8±1.1)d。平均住院时间(5.2±1.3)d。术后病理示良性病变9例,约占15.7%,恶性病变48例,约占84.2%。术后并发症:肺部感染3例(5.2%),肺不张1例(1.7%),少量咯血1例(1.7%),肺漏气2例(3 d,3.5%),心律失常4例(7.0%)。术后平均随访10个月,无支气管胸膜瘘、乳糜胸、包裹性胸腔积液等并发症,随访患者中无复发及远处转移病例。结论应用3D-CTBA及3D-VATS单操作孔行解剖性肺段切除治疗NSCLC的安全有效,适用于早期NSCLC以及不能耐受肺叶切除患者。
[Abstract]:Background & objective China is a high incidence area of lung cancer, its morbidity and mortality are the first in malignant tumors. The prevalence of low dose CT examination has significantly increased the detection rate of early lung cancer. Anatomical segmental resection is widely used in patients with stage Ia non-small cell lung cancer (NSCLC) and lung lobectomy. We used three-dimensional computed tomography bronchography and angiography3D-CTBAand three-dimensional video-assisted thoracic surery3D-VATSto perform anatomical pulmonary segmental resection with three-dimensional computed tomography bronchography and angiography3D-CTBAand three-dimensional video-assisted thoracic surgery technique. In order to investigate the clinical effect of NSCLC, the minimally invasive surgical technique was used to treat NSCLC. Methods retrospective analysis was performed on 57 cases of preoperative 3D-CTBA reconstruction of pulmonary lesions in the first people's Hospital affiliated to Suzhou University from October 2015 to April 2017. The anatomical segmental resection of NSCLC was performed with 3D-VATS single operating foramen. Results all patients with NSCLC were successfully treated by endoscopy. The mean operative time was 142.2 卤28.3 min, the average amount of intraoperative bleeding was 93.8 卤46.5 min, the average number of lymph nodes dissected was 9.1 卤2.2), the mean postoperative thoracic drainage volume was 429.8 卤181.2 mm / L, the mean time of indwelling thoracic tube was 2.8 卤1.1 d, the average hospitalization time was 5.2 卤1.3 d. The pathological changes were benign in 9 cases. Postoperative complications: pulmonary infection in 3 cases, pulmonary infection in 1 case, atelectasis in 1 case, hemoptysis in 1 case, hemoptysis in 1 case, pulmonary leakage in 2 cases in 3 days, arrhythmia in 4 cases, postoperative mean follow-up for 10 months, no bronchopleural fistula, chylothorax, There were no recurrence or distant metastasis in the patients with encapsulated pleural effusion and other complications. Conclusion 3D-CTBA and 3D-VATS single hole dissecting pneumonectomy is safe and effective in the treatment of NSCLC. It is suitable for the patients with early NSCLC and intolerable lobectomy.
【作者单位】：苏州大学附属第一人民医院胸外科;南京医科大学附属苏州市立医院北区胸外科;苏州大学附属第一人民医院放射科;
【分类号】：R734.2

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