单孔胸腔镜解剖性基底段切除术的临床应用

目的 分析单孔胸腔镜解剖性基底段切除术的临床应用结果.方法 回顾性分析2020年6～12月我院单个医疗组15例行单孔胸腔镜基底段切除术患者的临床资料,其中男4例、女11例,中位年龄53(32 ～70)岁.所有患者均经跨腋中线第5肋间切口,经叶间裂或肺下韧带入路,采用"单向式"思路结合"干-支法"完成解剖性各基底段切除....     

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....     

个体化肺结节三维重建模拟手术在胸腔镜肺段切除中的应用

目的探讨个体化肺结节三维重建模拟手术在胸腔镜肺段切除中的应用价值。方法 2018年12月～2019年12月接受手术治疗的肺结节病人60例,随机分为三维重建模拟手术组和非三维重建模拟手术组,每组各30例。比较两组围手术期相关指标的差异。结果两组均顺利完成胸腔镜下肺段切除术;三维重建模拟手术组术前与术中吻合率分别为:结节部位100%,靶段血管96.67%,靶段支气管96.42%;三维重建模拟手术组的手术时间、术中出血量、引流管留置时间、术后总引流量以及术后住院时间均低于非三维重建模拟手术组,差异有统计学意义(P0.05),两组术中清扫淋巴结个数与术后并发症发生率比较,差异无统计学意义(P0.05)。结论肺结节基于三维重建个体化胸腔镜解剖性肺段切除术安全有效,较常规手术更具临床应用价值。     

全胸腔镜解剖性肺段切除术12例报告

目的 探讨全胸腔镜肺段切除术的可行性、安全性及手术适应证.方法 2011年3月～2013年3月我院行胸腔镜解剖性肺段切除术12例,采用标准完全胸腔镜肺叶切除切口,按照解剖学依次用钉高2.5 mm 白色钉仓处理肺段动脉、肺段静脉,用钉高3.5 mm 蓝色钉仓处理支气管,同时进行系统淋巴结清扫.结果 12例均顺利完成胸腔镜解剖性肺段切除术,无中转开胸及辅助小切口.手术时间115～260 min,平均182 min;术中出血量100～300 ml,平均230 ml.胸腔引流时间2～6 d,平均3.5 d.术后住院3～11 d,平均7.5 d.无二次手术,无输血,无围手术期死亡.术后病理：腺癌6例,鳞癌2例,转移癌2例,炎性假瘤1例,结核球1例,其中原发非小细胞肺癌均为Ⅰa期.12例随访1～24个月,平均9个月,10例肺癌均无复发、转移.结论 全胸腔镜解剖性肺段切除术对于Ⅰa 期非小细胞肺癌及肺功能差或有其他合并症而不适合行肺叶切除者,是一种安全可行的选择.     

单向式胸腔镜基底段切除术352例的单中心回顾性研究

目的 分享单向式胸腔镜解剖性基底段切除术的临床应用经验。方法 回顾性分析2015年4月—2021年4月于四川大学华西医院行胸腔镜基底段切除术352例患者的临床资料,其中男96例、女256例,中位年龄50(26～81)岁。全组患者均通过胸腔镜手术,经叶间裂或肺下韧带入路,采用单向式思路结合“干-支法”完成各基底段解剖性切除。结果 全组患者均顺利完成手术,其中单孔手术49例、两孔手术3例、三孔手术300例,无增加切口或中转开胸者,无中转为肺叶切除者。中位手术时间118(45～340)min,中位术中出血量20(5～500)mL,中位术后引流时间2(1～22)d,中位术后住院时间4(2～24)d。术后并发症包括肺部感染6例、术后漏气时间>5 d或胸腔引流时间>7 d 18例、脑梗死1例、其它2例,所有患者均经治疗后好转出院。全组无住院期间死亡。结论 胸腔镜下采用单向式方法完成解剖性基底段切除术思路清晰,安全可行。     

基于倾向性评分匹配法探讨胸腔镜下解剖性肺段切除与肺叶切除对术后患者肺功能影响

目的:比较胸腔镜下解剖性肺段切除术和传统胸腔镜下肺叶切除术对患者肺功能的影响。方法:回顾分析2016年7月至2019年7月共326例胸腔镜肺手术患者,其中解剖性肺段切除术209例,肺叶切除术117例,所有手术由同一术者完成,根据性别、年龄、肿瘤位置、吸烟史、体质量指数等因素进行倾向性得分匹配,肺段切除组和肺叶切除组各8...     

单孔胸腔镜解剖性肺段切除术的临床应用与研究进展

随着肺癌精准诊疗的发展,解剖性肺段切除术成为治疗早期肺癌的重要术式。在电视胸腔镜手术获得广泛推广后,肺癌治疗已经进入微创时代。自2012年首次报道以来,单孔胸腔镜辅助解剖性肺段切除术已获得越来越多的临床应用。与开胸手术和传统胸腔镜手术相比,单孔胸腔镜手术创伤更小。目前,围绕单孔胸腔镜肺段切除术的主要研究热点包括具体适应证、长短期疗效以及学习曲线等。本文将从这一术式的特点、适应证和手术技术层面进行介绍,并基于最新循证证据总结讨论单孔胸腔镜肺段切除术应用的最新研究进展。     

全胸腔镜肺叶切除手术操作流程及技巧的优化:北京大学人民医院经验

目的 总结北京大学人民医院全胸腔镜肺叶切除手术的操作流程和技巧的优化改进经验.方法 2006年9月至2010年8月连续开展全胸腔镜肺叶切除手术408例,男214例,女194例,平均年龄58.6岁.实体肿瘤平均最大径30.1 mm.手术采用双腔气管插管全身麻醉,健侧单肺通气.胸腔镜观察口选择第7或8肋间腋后线,长1.5 cm;辅助操作切口选择在肩胛下角线第7或8肋间,长1.5 cm;主操作口选择在第4或第5肋间腋前线,长约4 cm,无需放置开胸器,不牵开肋骨.全部操作过程完全在胸腔镜下完成.术者位于病人前侧,双手分别握持吸引器和电凝钩,在主操作口内进行操作;助手位于病人背侧,使用卵圆钳经辅助操作口帮助牵拉显露.基本操作顺序与传统开胸肺叶切除相同.肺癌病人均清扫纵隔淋巴结:肿瘤位于右侧,清扫2、4、3A、3P、7、8、9、10组淋巴结;左侧清扫3、5、6、7、8、9、10组淋巴结,必要时清扫第4组淋巴结.结果 全组手术顺利,围手术期死亡1例,无严重并发症发生.平均手术时间195 min,平均术中出血249 ml.术后病理良性疾病86例,恶性疾病322例.全组中转开胸35例,中转开胸率8.6%.术后轻微并发症48例,并发症发生率11.8%.术后平均带胸管时间7.9天,术后平均住院天数10.9天.结论 全胸腔镜肺叶切除手术操作难度较高,开展此项手术应具备5个方面条件:(1)较清晰的胸腔镜设备,(2)良好的术野显露,(3)熟练的镜下血管解剖分离技巧,(4)能将血管和支气管置入缝合切开器内,(5)纵隔淋巴结清扫技术.掌握正确的操作流程及一些关键技巧,可以缩短学习曲线.     

机器人与胸腔镜在早期肺癌肺段切除术中短期疗效的对比研究

目的:分析机器人与胸腔镜手术在早期肺癌肺段切除中的临床疗效.方法:回顾性分析2019年1月～2020年12月在甘肃省人民医院接受达芬奇机器人和胸腔镜行肺段切除手术的106例早期肺癌患者的临床资料.其中接受RATS肺段切除术49例(男19例,女30例),年龄(59.13±9.38)岁;接受VATS 57例(男21例,女36例),年龄(60.36±10.06)岁,比较两组的临床疗效.结果:两组患者基线资料差异无统计学意义.RATS组与VATS组相比,手术时间(126.42min Vs 110.23min,P=0.007);术中失血量(40.46ml Vs 62.23ml,P=0.016);淋巴结清扫站数总数(6.32 Vs 5.21,P<0.001);淋巴结清扫总数(13.29 Vs 10.81,P=0.023);术后引流时间(4.29d Vs 5.66d,P=0.005);总引流量(772.53ml Vs 995.34ml,P=0.011);术后第1d疼痛评分(1.67 Vs 2.59,P=0.031)、第2d(2.74 Vs 3.71,P=0.025)、第3d(1.02 Vs 1.92,P=0.006);术后住院时间(4.45d Vs 6.39d,P=0.008);住院费用(90463.37元Vs 69872.21元,P<0.001),差异有统计学意义.而中转开胸手术、术后咳嗽、术后并发症、术后30d再入院率差异无统计学意义(P>0.05).结论:机器人手术系统在早期肺癌肺段切除术中,术中出血量少,住院时间短,淋巴结清扫优势大,术后疼痛感轻,操作安全有效且创伤小,可作为早期肺癌手术治疗的有效方法.     

达芬奇机器人与胸腔镜肺段切除术治疗早期非小细胞肺癌的有效性对比

目的:对比研究达芬奇机器人与胸腔镜下肺段切除术患者的围手术期数据,评价机器人肺段切除术的临床价值.方法:回顾性分析2018年12月～2020年2月在郑州大学第一附属医院胸外科行机器人肺段切除术68例患者(机器人组)和胸腔镜下肺段切除术49例患者(胸腔镜组)的临床资料.比较两组患者肺段切除类型、术后疼痛评分、住院费用、手术时间、术中失血量、清扫淋巴结组数及个数、术后住院时间、胸腔引流管留置时间、引流总量以及术后并发症发生情况,从而明确两种手术方式的有效性差异.结果:机器人组比胸腔镜组术后疼痛评分更低[(1.94±0.64)分Vs(2.29±0.65)分,P<0.05];N1淋巴结清扫的组数[1(1～2)组Vs 2(1～3)组,P=0.002]和数量[2(1～3)枚Vs 3(1～4)枚,P=0.014]有差异,机器人组优于胸腔镜组;住院费用为80815.00(47914.79～113023.66)元和98213.41(65302.90～155561.88)元,机器人组高于胸腔镜组(P<0.05).结论:机器人和胸腔镜肺段切除术对非小细胞肺癌的早期治疗是安全可行的,而机器人肺段切除术可能有更好的N1淋巴结清扫效果.     

A case of thoracoscopic medial basal segmentectomy

IntroductionIsolated resection of the medial basal segment (S7) is uncommon because of its small volume, and S7 segmentectomy is considered to be difficult due to anatomical variation. We report a case of successful thoracoscopic S7 segmentectomy.Presentation of caseA 56-year-old man was referred to our hospital with suspected pulmonary metastasis of rectal cancer. A 6-mm nodule was detected in S7. A7 and B7 branched from the basal segmental artery and bronchus, respectively, to run ventral to the inferior pulmonary vein. This made it possible to isolate A7 and B7 by an approach via the interlobar fissure.In addition, V7a and V7b were easily isolated from inferior pulmonary vein. The intersegmental plane was indicated by V7b and was transected along a demarcation line identified by using selective oxygenation via B7.DiscussionB7 most commonly branches from the basal bronchus and A7 from the basal artery to run ventral to the inferior pulmonary vein. With this anatomical type, when the surgeon approaches via the interlobar fissure during surgery, A7 is identified first, B7 is seen behind A7, and the IPV is posterior to B7. Since the intersegmental plane is located ventral to the IPV, segmentectomy can be completed via the interlobar fissure approach.ConclusionIn patients with this pattern of pulmonary artery and bronchial anatomy, isolated S7 segmentectomy is a feasible treatment option.     

Totally thoracoscopic basilar segmentectomy

We describe our technique of basilar segmentectomy by using a totally thoracoscopic approach without utility incision. We have performed 65 anatomical segmentectomies by using this approach. Nineteen of these were basilar segmentectomies. On the basis of this experience, we report useful technical details and our results. There was 1 conversion to thoracotomy because of inflammatory and fused fissure (1.5%). In the 18 remaining patients who had a totally endoscopic resection, the mean operative time was 191 minutes (range, 116-315 minutes). The mean operative blood loss was 73 mL (range, 10-150 mL). The postoperative course was uneventful in all but 1 patient who developed pulmonary edema that resolved after 2 days. Chest tubes were removed after a mean time of 2.8 days (range, 2-5 days), no patients had a prolonged air leak, and the mean postoperative stay was 6.1 days (range, 3-14 days).     

Stapled video-assisted thoracoscopic segmentectomy preserves as much lung volume as nonstapled video-assisted thoracoscopic segmentectomy

BackgroundTwo different techniques of performing segmentectomy have been reported in the era of video-assisted thoracosopic surgery (VATS), including stapled segmentectomy (SS) and non-stapled segmentectomy (NSS). Some surgeons favor stapled segmentectomy for better pneumostatic control, while others prefer non-stapled segmentectomy to avoid compromising adjacent pulmonary parenchyma. In this study, we used multidetector computed tomography (MDCT) and spirometry to evaluate lung volume preservation of different segmentectomy techniques.MethodsA total of 269 patients undergoing video-assisted thoracic surgery (VATS) segmentectomy between October 2013 and September 2016 in a single institution were reviewed. Perioperative outcomes, the cost of hospital admission, the change in forced expiratory volume in 1 s (FEV1) (ΔFEV1 and ΔFEV1%), and residual ipsilateral volume ratios (RiVR) were compared.ResultsThe final study population consisted of 107 patients: 30 patients underwent NSS, and 77 patients underwent SS. The NSS group had significantly longer operative time, more blood loss, longer duration of chest tube placement and postoperative hospitalization than the SS group. The follow-up of RiVR (at 6 months, 12 months, 24 months), ΔFEV1(L), and ΔFEV1(%) demonstrated no significant difference between NSS and SS group.ConclusionOur study demonstrated that postoperative residual lung volume was not influenced by different segmentectomy techniques.     

Surgical procedure of thoracoscopic and video-assisted anatomical segmentectomy for small peripheral lung cancer

Recently, small peripheral lung cancers which is indicated limited resection are frequently found by HRCT or PET. The limited resection for lung cancer includes thoracic and video-assisted anatomical segmentectomy (VATS segmentectomy) and wedge resection of the lung parenchyma. In anatomical segmentectomy, intra-plumonary lymph nodes are dissected, on the other hand, those lymph nodes can not be dissected in wedge resection. Consequently, segmentectomy will be radical procedure for lung cancer compared with wedge resection. Thoracic surgeons are required to perform anatomical segmentectomy for small peripheral lung cancer. The anatomical segmentectomy is not familiar procedure for recent thoracic surgeons. Thoracic surgeons should be skilled in that procedures. This is a review of basic procedures of VATS segmentectomy for lung cancer for young thoracic surgeones.     

Stump consolidation after video-assisted thoracoscopic segmentectomy

Pulmonary segmentectomy by video-assisted thoracic surgery (VATS) is used for minimally invasive surgery for removal of small lung neoplasms, and stump consolidation is one of the potential postoperative complications. The objective of the present study is to clarify the incidence of stump consolidation and its predictive factors by assessing patients who underwent VATS segmentectomy in our department. Stump consolidation was defined as atelectatic lesions along the surgical stump with >10 mm thickness in horizontal sectional view by computed tomography, at least 3 months after surgery. Between February 2007 and September 2010, 70 patients (38 men and 32 women) with primary lung cancer (43 patients) and metastatic pulmonary tumor (27 patients) underwent VATS segmentectomy. Stump consolidations were seen in 7 patients. Univariate analysis showed the significant difference for the period of performed operation. Left-sided operation, especially segmentectomy of left S(1+2), was another predictive factor, though not significant. Stump consolidation after VATS segmentectomy can be deueloped by conbined workspace for stapling and misidentification of intersegmental plane. When division of the intersegmental plane is difficult, open thoracotomy should be undertaken to prevent such compliance.     

Anatomical thoracoscopic segmentectomy for lung cancer

Minimally invasive surgery for lung cancer has seen considerable progress. A segmentectomy is less invasive than a lobectomy as it preserves lung parenchyma. The preservation of pulmonary function can reduce complications. The combination of a thoracoscopic approach with a segmentectomy should be less invasive, and retrospective studies have shown that the thoracoscopic approach is safe and feasible due to the lower postoperative mortality and complication rates as compared to an open thoracotomy. The validity of a segmentectomy for ground-glass-opacity-type lung cancer has been demonstrated, and it has also been evaluated for small, predominantly solid, lung cancers. Two prospective studies of segmentectomy versus lobectomy for ≤2-cm non-small-cell lung cancer are now underway (CALGB 140503 and JCOG0802/WJTOG4607L) and should clarify the role of segmentectomy. Regarding thoracoscopic segmentectomy, few retrospective studies have reported the oncological outcome for lung cancer and there is inadequate evidence regarding the long-term oncological outcome, although the perioperative complication rate and duration of hospital stay seem to be non-inferior to those of an open approach. For preoperative simulation, three-dimensional multidetector computed tomography (3D-CT) is essential for performing an atypical thoracoscopic segmentectomy safely. Preoperative 3D-CT angiography and bronchography (3D-CTAB) enable accurate identification of the venous branches in the affected segment and the intersegmental vein. This review describes the surgical and oncological outcomes, utility of 3D-CTAB, and surgical techniques and procedure used for a thoracoscopic segmentectomy.