同期胸腔镜下双侧肺多发结节切除手术40例病例研究

目的 总结同期胸腔镜下双侧肺切除手术治疗双肺多发结节的临床经验。 方法 回顾性分析2017年1月—2019年11月金华市中心医院40例双肺多发结节患者同期行双侧胸腔镜下肺切除术的临床资料。患者均经术前肺部CT、心电图、肺功能等检查行双肺结节定位、评估肺功能储备等情况,据此制定手术方案,行亚肺叶切除手术。考察手术相关指标(手术时间、病变直径、术中出血量、淋巴结数目)及围术期相关指标(术后引流时间、住院时间、术后肺功能指标FEV₁)、手术方式及术中、术后的并发症;对病理结果、临床疗效,手术相关并发症与手术术式的关联进行分析。 结果 40例患者共切除118个结节;其中恶性肿瘤及癌前病变86个(72.88%),分布于33例患者中,包括癌前病变4例,原发性肺癌26例,其他恶性肺部肿瘤3例;原发性肺癌TNM分期:0期7例,Ⅰ期14例,Ⅱ期4例,Ⅲ期1例,Ⅳ期0例;原发性肺癌伴有淋巴结转移5例,其中4例N1转移,1例N2转移。所有患者恢复顺利,住院期间无死亡病例,手术时间为(139.80±33.12)min,术中出血量为(150.00±23.63)mL,术后住院时间为(5.42±4.23)d,术后并发症包括肺部感染2例,心律失常2例,呼吸衰竭1例,手术相关并发症主要发生在肺叶-肺叶(并发症发生率为100.0%)、肺段-肺段(并发症发生率为50.0%)切除手术的患者。出院时评估术后近期疗效,行肺叶-楔形切除手术的患者中,存在部分无效的病例(2/30,6.67%)。 结论 经术前评估筛选的双肺多发结节患者同期行双侧胸腔镜下肺切除术安全有效,对不同病理类型患者需术前综合评估以确定最佳手术术式,获得更理想的近期疗效,减少并发症发生。 

Simultaneous thoracoscopic bilateral pneumonectomy of multiple pulmonary nodules by with 40 cases

Objective To summarize the clinical experience of simultaneous thoracoscopic bilateral pneumonectomy in the treatment of bilateral pulmonary nodules. Methods A retrospective analysis of the clinical data of 40 patients with multiple lung nodules underwent bilateral thoracoscopic pneumonectomy from January 2017 to November 2019. All patients were examined by CT, ECG and pulmonary function before operation to locate double pulmonary nodules and evaluate the pulmonary function reserve. According to the examination, the operation plan was made and sub lobectomy was performed. Operation related indicators(operation time, lesion diameter, intraoperative blood loss, number of lymph nodes) and perioperative related indicators(postoperative drainage time, hospital stay, postoperative pulmonary function index FEV₁), operation mode and intraoperative and postoperative complications; pathological results, clinical efficacy, surgical related complications and The correlation of surgical procedures was analyzed. Results A total of 118 nodules were resected from 40 patients, of which 86(72.88%) were malignant tumors and precancerous lesions, which were distributed in 33 patients. Among them, 4 cases were precancerous lesions, 26 cases were primary lung cancer, 3 cases were other malignant lung tumors. TNM stage of primary lung cancer: 7 cases were stage 0, 14 cases were stage Ⅰ, 4 cases were stage Ⅱ, 1 case was stage Ⅲ, 0 case was stage Ⅳ. Among the primary lung cancer, 5 cases had lymph node metastasis, 4 cases had N1 metastasis, 1 case had N2 metastasis. All patients recovered smoothly. There were no deaths during the hospitalization. The operation time was(139.80±33.12) min, the intraoperative bleeding volume was(150.00±23.63) mL, and the postoperative hospitalization time was(5.42±4.23) d. The postoperative complications included pulmonary infection in 2 cases, arrhythmia in 2 cases, and respiratory failure in 1 case. Surgical related complications mainly occurred in patients with lobectomy(complication rate was 100.0%) and segmental pulmonary segment(complication rate was 50.0%). At the time of discharge, the short-term curative effect was evaluated. Among the patients who underwent wedge resection of lung lobe, there were some invalid cases(2/30, 6.67%). Conclusion Patients with multiple pulmonary nodules screened by preoperative evaluation and undergoing simultaneous bilateral thoracoscopic pneumonectomy are safe and effective. For different pathological types of patients, preoperative comprehensive evaluation is needed to determine the best operation method, to obtain better short-term efficacy and low complications.