肺小结节胸腔镜解剖性肺段切除术初步报道

目的探讨胸腔镜解剖性肺段切除术的可行性及安全性。 方法回顾性分析解放军总医院第一医学中心胸外科2017年3月至2018年12月行胸腔镜解剖性肺段切除术的86例临床资料。手术均为3切口。对术后住院时间、术后并发症发生率等情况进行总结，对解剖性肺段切除术的现况、优势及适应证进行分析。 结果86例患者顺利施行了胸腔镜解剖性肺段切除术，手术顺利，无中转开胸或改行肺叶切除病例。平均手术时间(160.59±42.43)min，平均术中出血量(27.06±1.23)ml，平均淋巴结清扫数量(6.78±3.54)枚，平均胸腔闭式引流管留置时间(4.84±2.12)d，平均术后住院时间(6.53±1.41)d。术后病理：腺癌78例，鳞状细胞癌1例，黏液腺癌1例，良性结节6例，其中原发非小细胞肺癌均为Ⅰa期。术后均未出现严重并发症、复发及死亡。 结论解剖性肺段切除术创伤小、恢复快、术后住院时间短，其远期预后效果缺乏前瞻性数据支持，必须严格把控肺段切除术的适应证。

Thoracoscopic anatomical pulmonary segmentectomy for pulmonary nodule

ObjectiveTo investigate the feasibility and security of thoracoscopic anatomical pulmonary segmentectomy in the treatment of pulmonary nodule. MethodsDepartment of thoracic surgery, The First Medical Center of Chinese PLA General Hospital From Mar. 2017 to Dec.2018, we performed thoracoscopic anatomical pulmonary segmentectomy for 86 patients. Three incisions were used in our procedure. The postoperative hospital stay and incidence of postoperative complication were carried out. The status, advantages and indications of thoracoscopic anatomical segmentectomy were analyzed. ResultsAll the 86 patients underwent thoracoscopic anatomical pulmonary segmentectomy successfully without conversion to thoracotomy or lobectomy. The mean operation time was(160.59±42.43)min. The mean intraoperative blood loss was (27.06±1.23)ml. The mean number of lymph node dissections was(6.78±3.54). The chest tubes were maintained in position for(4.84±2.12)d. The mean postoperative hospital stay was (6.53±1.41)d. Postoperative pathological examination showed adenocarcinoma in 78 cases, squamous cell carcinoma in 1, mucinous adenocarcinoma in 1, benign nodule in 6 and the primary non-small cell lung cancer was classified as stageⅠa. No severe postoperative complications, death and local recurrence up to now. ConclusionsThoracoscopic anatomical pulmonary segmentectomy has the advantages of minimal trauma, fast recovery and short postoperative hospital stay. Its long-term prognosis is lack of prospective data support, so the indication of thoracoscopic anatomical pulmonary segmentectomy should be strictly controlled.