胸腔镜肺段切除术的临床结果分析

目的分析胸腔镜肺段切除术的临床结果,探讨胸腔镜肺段切除手术需要关注的临床问题,为更好开展胸腔镜肺段切除手术及减少围手术期并发症提供参考。方法回顾性分析我科2017年10月至2019年12月开展的计划行胸腔镜肺段切除手术90例患者的临床资料,其中男35例,平均年龄(60.34±9.40)岁;女55例,平均年龄(56.09±12.11)岁。比较患者临床资料,包括肺结节数量及良恶性情况、术前Hook-wire定位情况、术前规划和具体实施的术式、手术时间、术中出血量、术后引流量及引流管放置时间、术后住院时间及术后并发症等,总结经验教训。结果计划行胸腔镜下肺段切除的90例患者中,术前Hook-wire定位38例、直接手术52例;在胸腔镜下完成手术87例、中转开胸3例。中转开胸患者中有1例行肺叶切除术,胸腔镜下有3例在完成肺段切除术后被动行肺叶切除手术。全组患者平均手术时间(198.58±56.42)min,术中出血量(129.78±67.51)mL,淋巴结采样数量(6.43±1.41)枚,术后引流管放置时间(2.98±1.25)d,术后引流量(480.00±262.00)mL,术后住院时间(7.60±2.38)d。90例患者中,单发结节患者73例、多发结节患者17例。共切除肺结节113枚,其中良性结节14枚、恶性结节99枚,恶性占比为87.61%。无围手术期死亡及严重并发症。结论对符合指征的肺实质内结节,根据术前薄层CT及三维CT支气管血管重建结果做好规划,可采用胸腔镜解剖性肺段切除术;对肺段间结节、不易扪及的外周纯磨玻璃结节,术前采用Hook-wire定位可保证有效切缘并减少非计划肺叶切除术。

Clinical outcomes of thoracoscopic pulmonary segmentectomy

Objective To explore the clinical issues associated with video-assisted pulmonary segmentectomy and to provide reference for better implementation of thoracoscopic pulmonary segmentectomy and reduction of perioperative complications through analyzing the clinical results of thoracoscopic segmentectomy.Methods The clinical data of 90 patients who planned to undergo thoracoscopic segmentectomy in our department from October 2017 to December 2019 were retrospectively analyzed,including 35 males with an average age of 60.34±9.40 years and 55 females with an average age of 56.09±12.11 years.The data including lung nodule number,benign or malignant,preoperative location by Hookwire,preoperative planning and actual implementation,operation time,intraoperative blood loss,postoperative drainage volume and time of drainage tube removal,postoperative hospital stay and complications were collected and analyzed.Results Among the 90 patients,38 were preoperatively positioned by Hookwire,52 were directly operated on;87 were completed under thoracoscopic surgery among whom 3 underwent passive lobectomy after segmentectomy under thoracoscopic surgery,and 3 were converted to thoracotomy among whom 1 underwent lobectomy.Operation time was 198.58±56.42 min,intraoperative blood loss was 129.78±67.51 mL,lymph node samples were 6.43±1.41,drainage time was 2.98±1.25 d,the amount of postoperation drainage was 480.00±262.00 mL,hospital stay was 7.60±2.38 d.In all patients,73 had single nodules and 17 had multiple nodules.Totally 113 pulmonary nodules were resected,14(12.39%)were benign nodules and 99(87.61%)were malignant nodules.There was no perioperative death or serious complications.Conclusion For those pulmonary parenchymal nodules which meet the indications,it is feasible to perform thoracoscopic anatomic pulmonary segmentectomy according to preoperative thin-slice CT and three-dimensional computed tomography-bronchography and angiography(3 D-CTBA)reconstruction results.Preoperative Hookwire localization can ensure effective edge resection and reduce unplanned lobotomy for intersegmental nodules and non-palpable peripheral pure ground-glass nodules.