“精准医疗”理念下单孔VATS肺癌根治术的发展现状、应用细节和展望

单孔电视胸腔镜手术（uni-portal uideo-assisted thoracic surgery, Uni-VATS）的推广，是近年微创胸外科最重大的进展之一。随着腔镜下成像设备、切割缝合器械及电分离器械的改进，单孔VATS的应用范围已从最初的肺组织活检术逐渐扩大到解剖性肺叶/段切除、全肺切除、支气管/血管袖式吻合。多中心大量报道已证实：单孔VATS行肺叶切除安全、可行，清扫纵隔淋巴结的组数及总数均不低于传统多孔VATS，在疼痛、创伤及术后恢复方面也有积极的结果。虽然暂未得到多中心、大样本的临床数据如5年生存率，但有序地逐步开展单孔VATS仍是微创胸外科未来发展的重要方向。本文将围绕单孔VATS的原理及具体操作细节，结合肺癌根治术的基本操作理念进行讨论及综述，以期为单孔VATS的有序、规范化开展提出思考和探索。

Development,Application Details,and Prospects of Uni-VATS on Lung Cancer Radical Operation under the Concept of"Precise Medical Treatment"

Uniportal video-assisted thoracic surgery (Uni-VATS) has become one of the most exciting new develop-ments in minimally invasive thoracic surgery in recent 5 years. With the development of better thoracoscopic cameras and the availability of endoscopic linear mechanical staplers, experts in the technique are able to use uniportal VATS to encompass the most complex procedures such as bronchial sleeve/vascular reconstructions or carinal resections. A large number of multi-center reports have conifrmed that Uni-VATS lobectomy is safe and feasible;dissected node group number and total number of mediastinal lymph nodes were not less than that of traditional muli VATS;Uni-VATS gained positive results in pain, trauma and recovery time. Although the large sample multi center clinical data, such as the ifve year survival rate has not yet been obtained, gradually carring out of uni-VATS will be an important direction for the future development of minimally invasive thoracic sur-gery. hTis article will focus on the principle of Uni-VATS and the speciifc operation details, combined with the basic operation concept, with a view to put forward the orderly and standard utilization of the Uni-VATS.