双镜联合治疗同时性多原发肺癌13例临床分析

目的评估电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)联合电磁导航支气管镜(electromagnetic navigation bronchoscopy,ENB)引导微波消融(microwave ablation,MWA)治疗同时性多原发肺癌(Synchronous multiple primary lung cancer,sMPLC)的安全性和可行性。方法回顾性分析2017年3月~2020年9月我院接受VATS联合ENB引导MWA治疗的13例sMPLC病人的临床资料。结果 13例sMPLC总病灶数44个,其中手术切除31个,ENB引导MWA13个。手术方式以肺段切除为主,占46.2%。手术切除主病灶大小为(22.2±12.8)mm。MWA病灶大小为(10.2±5.8)mm。术后第1天引流量为(177.7±93.3)ml,术后胸管拔除时间为(2.8±1.8)天,术后住院时间为(3.7±1.8)天。术后发生1例持续性肺漏气,无其他并发症。术后随访平均时间为(10.6±10.5)个月,无复发及死亡。结论 VATS联合ENB引导MWA治疗sMPLC具有一定的安全性和可行性。通过手术切除主要病灶和淋巴结清扫,精确病理分期,从而指导术后个体化治疗。ENB引导MWA术并不会增加病人围术期风险,可减少手术切除范围,最大限度保留肺功能。

Clinical analysis of 13 cases of synchronous multiple primary lung cancer treated by the combination of thoracoscopy and bronchoscopy

Objective To investigate the safety and feasibility of the combination of video-assisted thoracoscopic surgery(VATS) and electromagnetic navigation bronchoscopy(ENB)-guided microwave ablation(MWA) for synchronous multiple primary lung cancer(sMPLC).Methods To retrospectively analyzed the clinical data of 13 patients with sMPLC in our hospital during the period from March 2017 to September 2020,who received VATS combined with ENB-guided MWA.Results A total of 44 lesions were in 13 patients with sMPLC.Surgical resection was performed in 31 lesions,and ENB-guided MWA was performed in 13 lesions.Segmentectomy was the main surgical method,accounting for 46.2%.The mean size of main resected lesions was(22.2±12.8)mm.The mean size of lesions ablated by microwave was(10.2±5.8)mm.Mean drainage of postoperative first day was(177.7±93.3)ml.Mean chest drain duration was(2.8±1.8)d.Mean length of postoperative hospital stay was(3.7±1.8)d.Postoperative persistent air leakage for more than 7 days existed in 1 patient.No others complications occurred.The mean follow-up time was(10.6±10.5)months.No recurrence or death occurred up to now.Conclusion VATS combined with ENB-guided MWA was a safe and feasible option for sMPLC.Accurate pathological staging was obtained by surgery to guide postoperative individualized treatment.Added ENB-guided MWA did not increase the patients’ perioperative risk,could reduce the surgical resection scope and protected lung function to the maximum extent.