小切口电视胸腔镜辅助与传统开胸肺癌根治术的比较

目的探讨小切口电视胸腔镜辅助肺癌根治术的临床价值。方法2005年1月～2006年6月收治49例I、Ⅱ期非小细胞肺癌,22例在小切口(腋前线肋间6～8cm)辅助电视胸腔镜下行肺叶切除术及肺门纵隔淋巴结清扫(VATS组),27例在常规开胸手术下完成肺叶切除术及淋巴结清扫(传统开胸组),比较2种术式肺功能和C反应蛋白(C reactiveprotein,CRP)的变化。结果胸腔镜组2例为方便安全地处理肺门血管将小切口扩大至12～15cm。2组患者术后血清CRP浓度明显升高,第1天达到峰值,胸腔镜组CRP术后1d(56.1±10.9)mg/L,显著低于传统开胸组(73.8±15.1)mg/L(t=-4.603,P=0.000)。2组术后肺功能每分钟通气量相对值(minute ventilation volume,MV)、1秒用力呼气容积相对值(forced expiratory volume in one second,FEV1)下降,术后1周时胸腔镜组MV为(95.6±16.4)L,显著高于传统开胸组(81.9±12.7)L(t=3.296,P=0.002),胸腔镜组FEV1为(57.1±5.7)%,显著高于传统开胸组(51.4±6.9)%(t=3.105,P=0.003)。结论与常规开胸肺癌根治术相比,小切口电视胸腔镜辅助肺叶切除术适合于早中期肺癌,疗效确切,可明显减少病人的手术创伤,可以作为非小细胞型肺癌的一种常规的治疗手段。     

早期拔除胸腔引流管在胸腔镜肺部手术后的应用

目的探讨胸腔镜肺部手术后早期拔除胸腔引流管的可行性和安全性,探索胸腔引流管的拔除指征。 方法选择2019年11月至2020年4月在南京大学医学院附属鼓楼医院行胸腔镜肺部手术,并于术后早期(48 h内)拔除胸腔引流管患者117例作为观察组;另外选择2018年11月至2019年4月在南京大学医学院附属鼓楼医院行胸腔镜肺部手术,但术后非早期拔除胸腔引流管患者114例作为对照组。两组在年龄(P＝0.476)、性别(P＝0.216)、术式(P＝0.715)、是否行纵隔淋巴结清扫或采样(P＝0.200)、目标肺叶(P＝0.925)、病变性质(P＝0.957)方面均差异无统计学意义。回顾性分析两组患者术后临床结果、拔除引流管后并发症及再次行胸腔引流情况。 结果观察组和对照组拔管前24 h引流量[(245.7±98.1)ml比(120.8±46.8)ml,P<0.001]、术后引流时间[(43.9±2.6)h比(84.5±10.5)h,P<0.001]、术后住院时间[(2.2±0.4)d比(4.2±1.1)d,P<0.001]、住院费用[(5.3±0.4)万元比(5.6±0.3)万元,P<0.001]、拔管后疼痛视觉模拟评分(visionl analogue scale, VAS) [(4.4±1.2)分比(3.3±1.2)分,P<0.001]、拔管后总体并发症发生率(20.5%比10.5%,P＝0.036)差异有统计学意义,观察组拔管前后VAS [(5.9±0.8)分比(4.4±1.2)分,P<0.001]和对照组拔管前后VAS [(6.0±0.9)分比(3.3±1.2)分,P<0.001]差异有统计学意义。观察组和对照组拔管前VAS [(5.9±0.8)分比(6.0±0.9)分,P＝0.464]、拔管后气胸(1.7%比0.9%,P>0.999)、胸腔积液(12.8%比6.1%,P＝0.084)、皮下气肿(2.6%比1.8%,P>0.999)、发热(3.4%比1.8%,P＝0.703)、再次行胸腔引流(2.6%比1.8%,P>0.999)发生率差异无统计学意义。 结论虽然术后早期拔除引流管可能会增加拔除引流管后胸腔积液的发生率,但早期拔除引流管可以明显减轻患者术后疼痛,并且不会增加气胸、皮下气肿、发热的发生率,也不会增加再次行胸腔引流的风险。因此,胸腔镜肺部手术后早期拔除胸腔引流管是安全、可行的,有利于减轻患者经济负担,缩短住院时间,促进患者加速康复。     

电视胸腔镜手术与开胸手术治疗肺癌的创伤程度比较

目的：比较电视胸腔镜手术与开胸手术治疗肺癌的创伤程度。方法将本院2010年2月~2013年6月本院收治的70例肺癌患者分为对照组和观察组,每组各35例,对照组患者给予开胸手术治疗,观察组患者给予电视胸腔镜手术治疗,比较两组患者血清、胸水中IL-6、α1-AT的变化。结果观察组患者术后1、3d时,血清、胸水的IL-6、α1-AT均低于对照组,差异有统计学意义（P＜0.05）。结论电视胸腔镜手术治疗肺癌校开胸手术对患者的创伤程度小。     

Comparison between robot-assisted thoracoscopic surgery and video-assisted thoracoscopic surgery for mediastinal and hilar lymph node dissection in lung cancer surgery

 Open in a separate windowOBJECTIVESLymph node dissection (LND) with robot-assisted thoracoscopic surgery (RATS) in lung cancer surgery has not been fully evaluated. The aim of this study was to compare LND surgical results between video-assisted thoracoscopic surgery (VATS) and RATS.METHODSWe retrospectively compared perioperative parameters, including the incidence of LND-associated complications (chylothorax, recurrent and/or phrenic nerve paralysis and bronchopleural fistula), lymph node (LN) counts and postoperative locoregional recurrence, among 390 patients with primary lung cancer who underwent lobectomy and mediastinal LND by RATS (n = 104) or VATS (n = 286) at our institution.RESULTSThe median total dissected LN numbers significantly differed between the RATS and the VATS groups (RATS: 18, VATS: 15; P < 0.001). They also significantly differed in right upper zone and hilar (#2R + #4R + #10L) (RATS: 12, VATS: 10; P = 0.002), left lower paratracheal and hilar (#4L + #10L) (RATS: 4, VATS: 3; P = 0.019), aortopulmonary zone (#5 + #6) (RATS: 3, VATS: 2; P = 0.001) and interlobar and lobar (#11 + #12) LNs (RATS: 7, VATS: 6; P = 0.041). The groups did not significantly differ in overall nodal upstaging (P = 0.64), total blood loss (P = 0.69) or incidence of LND-associated complications (P = 0.77).CONCLUSIONSIn this comparison, it was suggested that more LNs could be dissected using RATS than VATS, especially in bilateral superior mediastinum and hilar regions. Accumulation of more cases and longer observation periods are needed to verify whether RATS can provide the acceptable quality of LND and local control of lung cancer.     

电视胸腔镜下治疗肺叶切除术后支气管胸膜瘘

本文报道 2例肺癌患者行肺叶切除分别于术后第 4、7天出现支气管胸膜瘘。再次手术经VATS直接以无损伤编织线缝合封闭瘘口 ,外用医用合成胶或生物蛋白胶。 2例支气管膜瘘均治愈出院。     

肺部疾病中胸腔镜手术的应用研究

目的探讨胸腔镜手术在肺部疾病中的疗效。方法回顾性分析两年来电视胸腔镜手术治疗的15例患者的临床资料,并与同期的25例传统开胸手术作比较。结果经比较,VATS组手术时间、失血量、术后胸腔引流管放置时间和住院时间均明显短于传统开胸手术组,手术效果满意,无并发症发生。结论电视胸腔镜手术具有创伤小、出血少、手术时间短、康复快、风险小、疗效可靠及术后并发症少等优点,是值得临床推广、安全有效的治疗方法。     

电视胸腔镜手术在肺癌治疗中的应用

电视胸腔镜手术（video-assisted thoracoscopic surgery，VATS）是一种微创、安全、可行的技术。随着手术器械和技巧的日趋改进，电视胸腔镜在临床的应用越来越广泛。本文就电视胸腔镜手术在肺癌治疗中的应用作一综述。     

Learning curve for two-port video-assisted thoracoscopic surgery lung segmentectomy

 Open in a separate windowOBJECTIVESWhen lung cancer evolves from a large, centrally located mass to small, peripherally located pulmonary nodules, such as ground glass nodules, segmentectomy offers a reasonable method by which to save lung parenchyma without eliciting compromising oncological effects. To master these techniques, it is important to analyse the learning curve of surgeons. Therefore, the aim of the present study was to analyse the learning curve for two-port video-assisted thoracoscopic surgery (VATS) segmentectomy in our institution.METHODSWe retrospectively collected data from 86 consecutive patients who underwent two-port VATS segmentectomy between June 2019 and November 2019. The operative time (OT) and estimated blood loss and other complications were analysed. The learning curve was evaluated using the OT and the cumulative sum (CUSUM) value of OTs across all cases.RESULTSWe generated a graph of the CUSUM of OTs and found that the learning curve could be differentiated into 3 phases: phase 1, the initial learning phase (1st to 27th operation); phase 2, the increased competence phase (28th to 54th operation); and phase 3, the experienced phase (55th to 86th operation). The CUSUM value inflected at patient number 47. There were significant reductions in the OT and bleeding in phase 3 relative to phases 1 and 2. There were also significant differences in OT and estimated blood loss between the simple and complex segmentectomy procedures.CONCLUSIONSIn conclusion, the 3 phases identified using CUSUM analysis of the OT represented characteristic stages of the learning curve for two-port VATS segmentectomy. The data indicate that, in our institution, the inflection point for the learning curve was achieved after operating on 47 cases.     

Evaluation of video-assisted thoracoscopic surgery for pulmonary metastases: 11-years of experience

Background  Although video-assisted thoracoscopic surgery (VATS) has been applied to pulmonary resection for pulmonary metastases, the clinical validity of this approach remains controversial. The purpose of this study was to evaluate the validity and problems of VATS for pulmonary metastasectomy. Methods  From January 1993 to December 2003, VATS for pulmonary metastasectomy was performed in 53 resections for 48 patients at our institution. The medical records of these patients were retrospectively reviewed. Results  The primary tumor was colorectal cancer in 23 patients, renal cell carcinoma in 6, breast cancer in 6, germ cell tumor in 5, head and neck cancer in 2, and others in 6. Thirty-six cases had a solitary lesion, 8 had unilateral multiple lesions, and 9 had bilateral multiple lesions. The following procedures were performed: 7 lobectomies, 5 segmentectomies, and 41 wedge resections. There was no major postoperative morbidity related to VATS. At a median follow-up period of 29.0 months, 13 patients were alive without recurrences. The 3-year overall survival rate and the 3-year intrathoracic disease-free survival rate were 59.8% and 33.4%, respectively. Five cases had recurrence at the surgical stump or at the port sites, but these recurrences have not been found in the recent period since June 1997. Intrathoracic recurrences within 3 months after VATS occurred in four. Conclusion  VATS for pulmonary metastases is not superior to the conventional open thoracotomy and is not recommended as a standard procedure. Further studies with a larger number of cases performed by skilled surgeons familiar with VATS are needed.     

电视胸腔镜手术在胸外科的应用

目的探讨电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)在胸外科的应用. 方法回顾分析1998年7月～2002年12月78例胸腔镜手术的临床资料.其中:自发性气胸肺大疱切除40例,胸外伤探查12例,肺包块楔形切除9例,胸膜活检 胸膜固定6例,纵隔肿瘤切除4例,肺叶切除4例,肺叶切除术后支气管胸膜瘘2例,食管平滑肌瘤切除1例. 结果无一例中转开胸,5例因胸膜顶粘连辅助小切口.3例中老年自发性气胸术后持续漏气,分别于第7,8,13天拔除胸管,其余均在48h内拔除胸管.5例引流管口延期愈合.手术并发症发生率10.3%(8/78). 结论 VATS在胸外科有广阔的发展空间,一次性耗材价格昂贵限制其临床应用,腔镜下缝合技术或打结技术的应用比较适合目前的国情,节省医疗费用.     

Compromised video-assisted thoracoscopic segmental resection for high-risk patients with stage I lung cancer near the lung hilum

We performed a video-assisted thoracoscopic segmental resection without doing a mini-thoracotomy in two patients (one octogenarian and one with poor lung function) with early stage (T1-2N0) lung cancer located at the lung hilum who required preservation of their cardiopulmonary function. After 2 years of follow-up, both patients are alive without recurrence. We describe the cases and the method used for the video-assisted thoracoscopic segmental resection using an endoscopic stapler.     

电视胸腔镜技术在快速康复外科中的作用

目的探讨电视胸腔镜手术在快速康复外科中的作用。方法对308例患者行电视胸腔镜手术,选取手术时间、拔管时间、住院时间、手术切口长度、出血量等与280例开胸手术临床资料比较研究。结果308例患者中34例胸腔镜辅助小切口,4例中转开胸,共10例出现围手术期并发症,无死亡病例。结论胸腔镜手术与传统开胸手术相比,具有切口微创美观、出血量明显减少、痛苦轻、恢复快、手术时间短、手术并发症少、平均住院日短等优点,为胸内疾病开辟了新的诊疗方法。此项技术微创安全,同时符合快速康复外科的最新理念。     

Port-site recurrence following video-assisted thoracoscopic surgery

Video-assisted thoracoscopic surgery (VATS) is an established modality in the management of pleural diseases. We report a case of port-site recurrence following management of malignant pleural effusion in an elderly patient with extensive pleural metastasis from adenocarcinoma of the lung. Although her shortness of breath was relieved following VAT decortication and talc insufflation, at 3 months she was found to have a 2.5-cm subcutaneous nodule at the camera port site which on biopsy was confirmed to be metastatic in nature. Even though the nodule was asymptomatic and the patient prognosis was not affected, it is important that both the surgeon and future patients should be aware of this potential complication.     

三种胸腔镜肺癌切除术式的对比研究

目的对近距离两孔法、普通两孔法及三孔法胸腔镜肺叶切除及系统性淋巴结清扫3种不同的肺癌手术进行对比研究,比较三者的优点、缺点,为术式选择提供参考指标。 方法收集北京大学第一医院胸外科及北京医院胸外科两个医学中心2012年9月至2014年9月拟行肺叶切除加纵隔淋巴结清扫术患者319例,纳入研究265例,其中近距离两孔法组113例,普通两孔法组79例,三孔法组73例;收集围手术期的指标,进行对比研究。 结果3组患者术后均无死亡或严重并发症出现,术中出血量、术后引流量及拔除胸腔闭式引流管时间、术后并发症、术后住院时间和住院费用方面等指标比较,差异无统计学意义(P>0.05);近距离两孔法与另外两组手术时间、术中清扫淋巴结数目、术后疼痛等方面比较,差异有统计学意义[(241.5±56.8) min vs (112.5±0.8)min vs (119.1±12.6) min、(14.5±2.97) 个 vs (22.4±6.6)个 vs (21.3±3.7)个、(3.2±6.0)分 vs (7.8±7.1) 分 vs (10.3±6.5) 分,P<0.05]。 结论近距离两孔法胸腔镜肺叶切除及系统性纵隔淋巴结清扫术是安全可行的,术后疼痛方面明显好于另外两种术式。     

电视胸腔镜在食管疾病诊断与治疗中的应用

电视胸腔镜手术(VATS)作为一种微创技术应用于食管疾病的诊断和治疗已10年左右,其优点为减少术后早期和长期胸痛,减少术后呼吸道并发症,符合美学要求.VATS食管癌分期主要是评估食管癌外侵和转移情况,有助于选择合适的治疗方案.VATS治疗食管癌主要应用于早期食管癌切除,但由于手术部位多,操作较繁杂,应用受到一定的限制;而对食管良性疾病,如平滑肌瘤、贲门失弛缓症等在有条件的医疗中心已成为首选的手术方案.     

Video-assisted thoracoscopic surgery (VATS) segmentectomy for small peripheral lung cancer tumors: intermediate results

Background We investigated the feasibility and suitability of video-assisted thoracoscopic surgery (VATS) segmentectomy for curing selected non-small cell lung cancer (NSCLC) with this less invasive technique Methods We performed VATS segmentectomy for small (<20 nm) peripherally located tumors and pathologically confirmed lobar lymph node-negative disease by frozen-section examination during surgery. Of the 34 patients who underwent this limited resection, 22 were treated with complete hilar and mediastinal lymph node dissection (intentional group), whereas 12 patients who were deemed to be high risk in their toleration for lobectomy underwent VATS segmentectomy with incomplete hilar and mediastinal lymph node dissection (compromised group). The surgical and clinical parameters were evaluated and compared with those of segmentectomy under standard thoracotomy to evaluate the technical feasibility of VATS segmentectomy. Results We found that VATS segmentectomy could be performed safely with a nil mortality rate and acceptably low morbidity. The mean period of observation was relatively short at 656.7±572.1 and 783.4±535.8 days in the intentional and compromised groups, respectively. At the time of writing, all intentional patients remain alive and free of recurrence. There were two cases of non-cancer-related death in the compromised group. Clinical data indicated that VATS segmentectomy caused the same number or fewer surgical insults compared with segmen-tectomy under standard thoractomy Conclusions The present results are intermediate only; the rate of long-term survival and the advantages of the less invasive procedure still need further investigation. Nevertheless, we believe that VATS segmentectomy with complete lymph node dissection is a reasonable treatment option for selected patients with small peripheral NSCLC.     

基层医院如何开展胸腔镜手术及手术成本控制对策

目的探讨如何在基层医院开展电视胸腔镜手术及手术成本控制对策。方法利用自制器械对308例患者行电视胸腔镜手术,通过改进技术、制定不同术式的方法控制手术成本。结果 308例患者中34例胸腔镜辅助小切口,4例中转开胸,共10例出现围手术期并发症,发生率为3.42%,无死亡病例。结论通过自制器械,制定合理的学习曲线,加强手术成本控制,手术费用明显降低,使基层不发达地区患者也能共享微创技术带来的福音。     

82例电视胸腔镜的临床应用

目的　总结电视胸腔镜手术 (VATS)在胸外科疾病治疗中的临床应用经验。方法　回顾分析 1999年 6月至 2 0 0 1年 2月采用VATS治疗 82例病人的临床资料。结果　全组病人无院内死亡和并发症发生 ,全部痊愈出院。结论　VATS具有创伤小、痛苦轻、恢复快和对美容影响小的优点。自发性气胸、肺大疱切除可作为VATS的首选术式。VATS为胸内疾病的诊断和治疗提供了一种重要手段 ,但目前临床应用有局限性     

非气管插管麻醉在胸腔镜手术中的应用

背景 电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)应用传统气管插管全身麻醉机械通气引起的气道损伤及急性肺损伤等并发症影响患者术后恢复和生活质量.近年来非气管插管麻醉行VATS的安全性及可行性受到胸外科医师和麻醉医师的广泛关注. 目的 推进对于VATS期间应用非气管插管麻醉的认识和应用. 内容 回顾近年来国内外关于非气管插管麻醉下行VATS治疗胸科疾病的临床研究情况,总结其安全性、可行性及相对于传统方式的优势和目前存在的问题. 趋向 非气管插管麻醉作为一项新技术在VATS中的应用亟待更多的临床研究.