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  • 范海洋,王瑾,陈蓓,杨晨路,陈健,黄靖,蒋雷.剑突下单孔胸腔镜解剖性肺段切除治疗早期肺部恶性肿瘤及局限性良性病变220例临床分析[J].第二军医大学学报,2019,40(8):833-838    [点击复制]
  • FAN Hai-yang,WANG Jin,CHEN Bei,YANG Chen-lu,CHEN Jian,HUANG Jing,JIANG Lei.Subxiphoid uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy for early malignant tumors and localized benign lesions: a clinical analysis of 220 cases[J].Acad J Sec Mil Med Univ,2019,40(8):833-838   [点击复制]
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剑突下单孔胸腔镜解剖性肺段切除治疗早期肺部恶性肿瘤及局限性良性病变220例临床分析
范海洋1,2,王瑾1,陈蓓1,杨晨路1,陈健1,黄靖3*,蒋雷1*
0
(1. 同济大学附属上海市肺科医院胸外科, 上海 200433;
2. 中山大学附属第七医院心胸血管外科, 深圳 518107;
3. 同济大学附属上海市肺科医院呼吸科, 上海 200433
*通信作者)
摘要:
目的 观察剑突下单孔胸腔镜解剖性肺段切除治疗早期肺部恶性肿瘤及局限性良性病变的治疗效果。方法 回顾性分析2014年9月至2017年4月同济大学附属上海市肺科医院收治的220例剑突下单孔胸腔镜解剖性肺段切除手术患者的临床资料。术后定期随访,评价切口疼痛及手术治疗效果。结果 患者平均年龄为(56.34±10.66)岁,男68例(30.91%)、女152例(69.09%)。平均手术时间为(2.07±0.72)h,术中平均失血量为(91.64±94.20)mL,平均术后住院时间为(4.64±9.97)d。共14例术中转换了手术方式,其中7例(3.18%,7/220)术中增加肋间辅助操作孔,3例(1.36%,3/220)因医源性血管或支气管损伤中转为剑突下单孔胸腔镜肺叶切除术,4例中转为开胸手术(1.82%,4/220)。术后主要并发症(术后出血)的发生率为0.45%(1/220),均未发生支气管胸膜瘘或切口疝,无围手术期死亡,术后30 d生存率为100.00%。220例患者共切除227个病灶,其中183个(80.62%)为恶性肿瘤,其余为良性或癌前病变。术后中位随访时间为30个月,未发生术后顽固性切口疼痛,仅2例患者出现切口及周围皮肤爬痒感,1例患者出现切口及周围皮肤感觉减退,所有恶性肿瘤患者均无复发或转移。结论 剑突下单孔胸腔镜解剖性肺段切除是治疗早期恶性肿瘤和局限性、良性病变的有效方法,可以明显避免术后切口疼痛,达到满意的肿瘤学治疗效果。
关键词:  剑突下入路  解剖性肺段切除术  单孔胸腔镜手术  肺肿瘤
DOI:10.16781/j.0258-879x.2019.08.0833
投稿时间:2019-02-18修订日期:2019-05-11
基金项目:上海市卫生和计划生育委员会卫生行业临床研究专项计划(20184Y0090).
Subxiphoid uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy for early malignant tumors and localized benign lesions: a clinical analysis of 220 cases
FAN Hai-yang1,2,WANG Jin1,CHEN Bei1,YANG Chen-lu1,CHEN Jian1,HUANG Jing3*,JIANG Lei1*
(1. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China;
2. Department of Thoracic and Vascular Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, Guangdong, China;
3. Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
*Corresponding authors)
Abstract:
Objective To observe the therapeutic effect of subxiphoid uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy in the treatment of the early malignant lung tumors and localized benign lung lesions. Methods A retrospective analysis was conducted on the clinical data of 220 patients with early malignant lung tumors or localized benign lung lesions undergoing subxiphoid uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy in the Shanghai Pulmonary Hospital of Tongji University between Sep. 2014 to Apr. 2017. Follow-up after operation was performed regularly to evaluate incision pain and surgical outcome. Results The average age of 220 patients was (56.34±10.66) years, and 68 cases (30.91%) were males and 152 cases (69.09%) were females. The average operation time was (2.07±0.72) h, the average perioperative blood loss was (91.64±94.20) mL, and the average postoperative hospital stay was (4.64±9.97) d. A total of 14 patients underwent surgical conversion during the operation. Among them, 7 cases (3.18%, 7/220) had additional intercostal auxiliary hole during operation, 3 (1.36%, 3/220) were converted to subxiphoid uniportal video-assisted thoracoscopic lobectomy due to iatrogenic vascular or bronchial injury, and 4 cases (1.82%, 4/220) were converted to thoracotomy. The incidence of major complication (bleeding) was 0.45% (1/220). No patients suffered from bronchopleural fistula or developed incisional hernia. There were no perioperative deaths, with a postoperative 30 d survival rate of 100.00%. A total of 227 lesions were resected in 220 patients, 183 (80.62%) were malignant and the rest were benign or precancerous lesions. The median follow-up time was 30 months. No postoperative intractable incision pain occurred. Only 2 patients had itching of incision and surrounding skin, and 1 patient had hyposensation of incision and surrounding skin. No recurrence or metastasis occurred in patients with malignant tumors. Conclusion Subxiphoid uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy is an effective method for early malignant tumors and localized benign lesions. It can alleviate postoperative incision pain and has satisfactory therapeutic effects.
Key words:  subxiphoid approach  anatomic pulmonary segmentectomy  uniportal video-assisted thoracoscopic surgery  lung neoplasms