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中华胸部外科电子杂志 ›› 2016, Vol. 03 ›› Issue (02) : 83 -88. doi: 10.3877/cma.j.issn.2095-8773.2016.02.004

所属专题: 文献

论著

单孔全胸腔镜解剖性肺段切除术治疗早期非小细胞肺癌
梁明强1, 陈椿1,(), 郑炜1, 吴维栋1, 朱勇1, 郭朝晖1   
  1. 1. 350001 福州,福建医科大学附属协和医院胸外科
  • 收稿日期:2016-03-20 出版日期:2016-05-28
  • 通信作者: 陈椿

Single-port thoracoscopic anatomic segmentectomy for early-stage non-small cell lung cancer

Mingqiang Liang1, Chun Chen1,(), Wei Zheng1, Weidong Wu1, Yong Zhu1, Zhaohui Guo1   

  1. 1. Department of Thoracic Surgery, Union Hospital affiliated to Fujian Medical University, Fuzhou 350001. China
  • Received:2016-03-20 Published:2016-05-28
  • Corresponding author: Chun Chen
  • About author:
    Corresponding author: Chen Chun, Email:
引用本文:

梁明强, 陈椿, 郑炜, 吴维栋, 朱勇, 郭朝晖. 单孔全胸腔镜解剖性肺段切除术治疗早期非小细胞肺癌[J/OL]. 中华胸部外科电子杂志, 2016, 03(02): 83-88.

Mingqiang Liang, Chun Chen, Wei Zheng, Weidong Wu, Yong Zhu, Zhaohui Guo. Single-port thoracoscopic anatomic segmentectomy for early-stage non-small cell lung cancer[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2016, 03(02): 83-88.

目的

总结单孔全胸腔镜解剖性肺段切除术治疗早期非小细胞肺癌(NSCLC)的临床经验。

方法

回顾性分析2014年5月至2015年3月在福建医科大学附属协和医院胸外科行单孔全胸腔镜解剖性肺段切除术治疗27例早期NSCLC患者的临床病例资料。采用双腔气管内插管、健侧单肺通气,于腋前线第4或第5肋间做一个长4~5 cm的手术切口,先完成解剖性肺段切除,如术中病理证实为NSCLC则进一步行纵隔淋巴结清扫或采样。主要观察指标包括围手术期资料(手术时间、出血量、引流管放置时间、住院时间等)、肿瘤手术效果(淋巴结切除总数、纵隔淋巴结切除站数、纵隔淋巴结切除数)及术后疼痛评分。

结果

所有病例均在单孔全胸腔镜下完成手术,无增加辅助腔镜切口、无中转开胸病例。无围手术期死亡病例,有3例患者发生并发症(肺部感染2例,心律失常1例),经治疗后均痊愈,并发症发生率为11.1%。27例早期NSCLC患者的平均手术时间(192.2±56.1)min,术中出血量(83.8±50.5)ml,术后拔管时间(4.5±1.3)d,术后住院时间(6.2±2.7)d,术后疼痛VAS评分(3.4±0.9)分。手术效果显示:每例患者平均淋巴结切除总数(13.7±5.3)枚,纵隔淋巴结切除总数(9.5±4.3)枚,纵隔淋巴结切除站数(5.6±1.3)站。

结论

在有丰富腔镜手术经验的治疗中心,单孔全胸腔镜解剖性肺段切除术治疗早期NSCLC在技术上是安全可行的,是一种更为微创的手术方法。

Objective

To summarize the clinical experience of single-port thoracoscopic anatomic segmentectomy for early-stage non-small-cell lung cancer(NSCLC).

Methods

The clinical data of 27 patients undergoing single-port thoracoscopic anatomic segmentecomy for early-stage NSCLC in Department of Thoracic Surgery, Union Hospital affiliated to Fujian Medical University between May 2014 and March 2015 were retrospectively analyzed. A double lumen endotracheal tube was input, and the contralateral one-lung ventilated. A 4-5 cm incision was put on the anterior axillary line in the 4th or 5th intercostal space. Anatomic segementecomy was carried out firstly, and mediastinal lymph node dissection or sampling was executed when NSCLC was confirmed by intraoperative frozen pathology. The outcomes included perioperative parameters (operative time, volume of blood loss, duration of drainage, length of postoperative hospital stay, etc.), oncological results (total number of lymph node resection, total number of mediastinal lymph node resection, and number of stations of mediastinal lymph node resection), and pain score.

Results

All cases of single-port thoracoscopic surgery were completed, without adding auxiliary incision or converting to thoracotomy. There was no case of perioperative death, while there were 3 cases of complications (2 cases of pulmonary infection, and 1 case of arrhythmia), with the prevalence of complications of 11.1%. All cases of complications were cured. The mean operative time was (192.2 ± 56.1) min, the volume of blood loss was (83.8 ± 50.5) ml, the duration of drainage was (4.5±1.3) d, the length of postoperative hospital stay was (6.2±2.7) d, and the postoperative pain VAS score was (3.4 ± 0.9). The total number of lymph node dissection was (13.7±5.3), the total number of mediastinal lymph node dissection was (9.5 ± 4.3), and the number of stations of mediastinal lymph node dissection was (5.6±1.3).

Conclusion

In an center with extensive experience of thoracoscopic surgery, the single-port thoracoscopic anatomic segmentectomy for early-stage NSCLC is technically feasible and safe, and is a more minimally invasive surgical approach.

表1 单孔胸腔镜解剖性肺段切除术的肺段分布情况
图1 单孔胸腔镜手术技巧。A.扶镜手的站位;B.胸腔镜一般需要紧靠切口上缘,既有利于术者器械进出,也有利于维持镜像稳定;C.采用一直一弯两种器械,器械前端自然形成的夹角有利于暴露视野;D.选择丝线结扎,可大大降低血管损伤引起大出血等风险。
[1]
OkadaM,NishioW,SakamotoT, et al. Effect of tumor size on prognosis in patients with non-small cell lung cancer: the role of segementectomy as a type of lesser resection[J]. J Thorac Cardiovesc Surge,2005,129(1):87-93.
[2]
MchuchertMJ,AbbasG,AwaisO,et al.Anatomic segmentectomy for the solitary pulmonary nodule and early stage lung cancer[J]. Ann Thorac Surg,2012,93(6):1780-1785.
[3]
MiglioreM. Efficacy and safety of single-trocar technique for minimally invasive surgery of the chest in the treatment of noncomplex pleural disease[J]. J Thorac Cardiovasc Surg,2003,126(5):1618-1623.
[4]
RoccoG,Martin-UcarA,PasseraE. Uniportal VATS wedge pulmonary resections[J]. Ann Thorac Surg,2004,77(2):726-728.
[5]
Gonzalez-RivasD,De la TorreM,ParadelaM, et al. Video-assisted thoracic surgery lobec-tomy: 3-year initial experience with 200 cases[J]. Eur J Cardiothorac Surg, 2011,40(1):e21-e28.
[6]
Gonzalez-RivasD,FieiraE,MendezL, et al. Single-port video-assisted thoracoscopic anatomic segmentectomy and right upper lobectomy[J]. Eur J Cardiothorac Surg, 2012,42(6):e169-e171.
[7]
ShapiroM,WeiserTS,WisniveskyJP, et al. Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stage Ⅰ lung cancer[J]. J Thorac Cardiovasc Surg, 2009,137(6):1388-1393.
[8]
El-SherifA,GoodingWE,SantosR, et al. Outcomes of sublobar resection versus lobectomy for stage Ⅰ non-small cell lung cancer: a 13-year analysis[J]. Ann Thorac Surg, 2006,82(2):408-415.
[9]
SchuchertMJ,PettifordBL,KeeleyS, et al. Anatomic segmentectomy in the treatment of stage I non-small cell lung cancer[J]. Ann Thorac Surg, 2007 84(3):926-932.
[10]
ZhaoX,QianL,LuoQ, et al. Segmentectomy as a safe and equally effective surgical option under complete video-assisted thoracic surgery for patients of stage Ⅰ non-small cell lung cancer[J]. J Cardiothorac Surg, 2013,8:116.
[11]
KeenanRJ,LandreneauRJ,MaleyRH Jr, et al. Segmental resection spares pulmonary function in patients with stage Ⅰ lung cancer[J]. Ann Thorac Surg, 2004,78(1):228-233.
[12]
SaitoH,NakagawaT,ItoM, et al. Pulmonary function after lobectomy versus segmentectomy in patients with stage Ⅰ non-small cell lung cancer[J]. World J Surg, 2014,38(8):2025-2031.
[13]
ChenPR,ChenCK,LinYS, et al. Single-incision thoracoscopic surgery for primary spontaneous pneumothorax[J]. J Cardiothorac Surg,2011,6:58.
[14]
BertolacciniL,RoccoG,VitiA, et al. Geometrical characteristics of uniportal VATS[J]. J Thorac Dis, 2013,5(Suppl 3):S214-S216.
[15]
Gonzalez-RivasD. Evolving thoracic surgery: from open surgery to single port thoracoscopic surgery and future robotic[J]. Chin J Cancer Res, 2013,25(1):4-6.
[16]
LiuCY,LinCS,ShihCH, et al. Single-port video-assisted thoracoscopic surgery for lung cancer[J]. J Thorac Dis, 2014,6(1):14-21.
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