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。     

记忆合金定位针在胸腔镜肺小结节切除术中的应用价值

目的:探讨术前一次性使用肺结节记忆合金定位针在胸腔镜肺小结节切除术中的可行性、准确性及安全性。方法:2022年10月至2023年2月为40例单发肺小结节患者经术前定位后行胸腔镜切除术。结节直径5～19 mm,平均(11.0±4.1)mm;距脏层胸膜深度5～23 mm,平均(10.2±4.3)mm。胸腔镜术前在CT引导下采用一次性使用肺结节记忆合金定位针定位。结果:全组40例肺小结节均成功经皮肺穿刺置入记忆合金定位针,“宝塔形弹簧圈”前端均锚定在肺结节附近。定位并发症为无症状气胸3例,少量肺内出血3例,均无需处理。术中发现定位成功率100%,无“宝塔形弹簧圈”脱位。手术时间平均(31.7±10.4)min,术中出血(8.7±4.5)mL,术后平均住院(3.0±1.5)d。结论:CT引导下一次性使用肺结节记忆合金定位针用于肺小结节术前定位是安全、有效、简单的定位方法,尤其对于体积小、实性成分少的磨玻璃结节,具有重要的临床应用价值,值得推广应用。     

胸腔镜辅助小切口手术诊治肺周围型结节

目的探讨胸腔镜辅助小切口手术在诊断和治疗肺周围型结节病变中的临床应用价值。方法胸腔镜辅助小切口手术诊治肺周围型结节55例，其中单发结节54例，多发结节1例。肺楔形切除术23例；肺叶切除联合淋巴结清扫治疗原发性肺癌32例，采用常规开胸手术器械及胸腔镜用器械切除肺叶，自制淋巴结摘除钳完成淋巴结清扫。结果55例均在胸腔镜下完成手术。手术时间35～180min，平均109min，术中出血量50～400ml，平均122min。均未输血，1例术后漏气术后32d出院，1例切口延迟愈合，术后19d出院，余53例术后住院4～11d，平均8．3d。无严重并发症。术后病理：良性病变15例，原发性肺癌38例，非典型性腺瘤样增生1例，转移性肺癌1例。良性病变行肺楔形切除术，32例原发性肺癌行解剖学肺叶切除联合淋巴结清扫，4例肺癌胸膜广泛播散未手术处理，2例肺癌因肺功能差行姑息性肺楔形切除。结论胸腔镜辅助小切口手术有助于明确诊断肺周围型结节病变，治疗临床早期原发性肺癌的长期疗效有待随访观察。     

电视胸腔镜手术在肺结节诊治中的研究进展

现代医疗条件下肺结节的检出率逐年升高,而手术中识别和治疗小型肺部病损仍然具有挑战性,其难点在于如何更好地将手术和肿瘤学原理与更微创、更适当的肺保留手术相融合。为了满足肺结节发生率增加的需求及其外科治疗模式的转变,电视辅助胸腔镜手术(VATS)领域已有许多相应的发展和创新。近年来,单孔VATS和非插管麻醉VATS的兴起明显降低了VATS的侵入性,裸眼3D显示系统、图像引导下的VATS、杂交手术室和荧光胸腔镜检查技术的出现更有助于提高VATS的精准度,成为诊疗肺结节的重要辅助手段。文章探讨了近期VATS技术的发展重点及其在肺结节手术管理中的作用。     

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....     

电视胸腔镜辅助下小切口手术在肺结节样病变治疗中的应用体会

现代电视胸腔镜外科手术(video-assisted thoracicsurgery,VATS)是近年来兴起的胸外科手术,它具有创伤小、恢复快、疗效可靠等优点,但手术中一次性消耗材料费用昂贵,在一定程度上限制了这项技术的推广应用。我院自1997年6月至2003年6月采用电视胸腔镜辅助腋下小切口(video-assisted minithoracotamy,VAMT)行肺结节样病变治疗35例,取得较满意疗效,与同期常规切口治疗肺结节样病变30例比较,具有一定优越性,现报告如下。临床资料1.一般资料:因发热、胸痛、咳嗽等症状(41例)或无自觉症状常规体检(24例),进行胸部正侧位X线片、CT等检查,发现…     

单孔胸腔镜复杂肺段切除术在直径≤2 cm磨玻璃结节中的应用

目的 探讨单孔胸腔镜复杂肺段切除术治疗直径≤2 cm磨玻璃结节(ground-glass nodule, GGN)的安全性。方法 2019年1月～2021年12月,对58例直径≤2 cm的GGN行单孔胸腔镜复杂肺段切除术。结节位于除了双侧S6(背段)、左侧S1+2+3(固有段)和左侧S4+5(舌段)以外的肺段,或者结节切除的手术方式需要处理段间平面超过2个以上。结果 均在单孔胸腔镜下行复杂肺段(21例)、联合肺段(24例)、肺亚段(2例)、联合肺亚段(11例)切除术,无重大并发症。病理诊断原位腺癌7例,微浸润腺癌38例,浸润性腺癌13例。结论 对于直径≤2 cm的GGN,单孔胸腔镜复杂肺段切除术在围手术期具有安全性和可行性。     

单孔胸腔镜下铥激光肺楔形切除术治疗肺小结节的回顾性队列研究

目的 比较单孔胸腔镜辅助下铥激光肺楔形切除术与其它两种传统方法（机械性切割吻合器肺楔形切除术、肺段切除术）在肺小结节手术治疗中的有效性及安全性。方法 回顾性分析2017年12月—2018年12月首都医科大学宣武医院收治的125例单孔胸腔镜辅助下肺部小结节手术患者的临床资料。按照手术方式将患者分为三组：铥激光楔形切除术（铥激光组）33例,男10例、女23例,平均年龄（59.21±11.31）岁;机械性切割吻合器肺楔形切除术（吻合器楔形术组）48例,男17例、女31例,平均年龄（57.27±11.30）岁;肺段切除术（肺段切除术组）44例,男21例、女23例,平均年龄（63.00±9.68）岁。比较三组患者手术中肺断面漏气分级、手术时间、术中出血量、术后住院时间、引流管留置时间、日平均引流量、发热、疼痛及住院费用等指标差异。结果 三组患者一般指标中,体重指数、性别、吸烟史、病理结果的良恶性比例、病灶最大直径、病灶位置分布情况差异均无统计学意义（P>0.05）。铥激光组患者年龄和胸膜粘连比例与其它两组差异亦无统计学意义（P>0.05）。在病灶个数的分布上,吻合器楔形术组多病灶的比...     

肺结节三维重建胸腔镜肺段切除的应用价值

目的:探讨肺结节患者采取胸腔镜肺段切除治疗时,三维重建模拟的价值。方法:选择福州肺科医院2018年6月到2021年6月收治的60例肺结节患者,所有患者均实施胸腔镜肺段切除治疗,依照数字表法进行分组,两组患者均采取肺段切除术治疗,分为对照组(基础措施)、研究组(三维重建模治疗)。对比治疗结果。用SPSS19.0软件展开统...     

Fluoroscopy-aided thoracoscopic resection of pulmonary nodule localized with contrast media

BACKGROUND: The pulmonary nodules have become the major indication of video-assisted thoracic surgery (VATS). Recently, several preoperative or intraoperative techniques for identifying small or deeply seated pulmonary nodules have facilitated thoracoscopic resection. We describe the new technique for detecting difficult lesions. METHODS: Preoperatively, we marked the visceral pleura near the pulmonary nodules with dye, simultaneously injected contrast media (1 water-soluble Optiray [Mallinckrodt Medical Inc, Quebec, Canada], 18 barium sulfate, 11 Lipiodol [Laboratoire Guerbet, Aulnay-sous-Bois, France]) into or around the nodule under computed tomography (CT) guidance. During VATS, we were able to easily and accurately detect and resect all the nodules localized with contrast media, of which the radiopacity was visualized on the portable fluoroscopic monitor. RESULTS: Between February 1996 and December 1998, we thoracoscopically resected 30 nodules in 28 patients (13 were women; age, 53 +/- 14 years). The resected nodules were 17 +/- 7.6 mm (range; 4 to 32 mm) in size, and 8.9 +/- 8 mm (range, 2 to 34 mm) in depth. The pathologic diagnosis of the nodules was benign in 20 and malignant in 10 (six primary cancers of lung and four metastatic cancers). There were only minor complications related CT localization. CONCLUSIONS: This new technique can help the surgeons detect and resect the difficult lesions with safety and rapidity by VATS without thoracotomy.     

胸腔镜术前CT引导下新型肺结节定位针定位肺小结节

目的 观察胸腔镜术前CT引导下新型肺结节定位针定位肺小结节的效果。方法 回顾性分析50例肺结节患者共53枚肺小结节,直径5.0~15.0 mm,均于CT引导下以新型肺结节定位针定位病灶后接受电视辅助胸腔镜手术（VATS）,观察定位效果及并发症。结果 对50例53个病灶均成功植入锚定定位针,定位成功率为100%（53/53）。穿刺过程中9例（9/50,18.00%）穿刺针道附近轻微出血;定位术中14例（14/50,28.00%）出现轻度气胸,1例（1/50,2.00%）发生胸膜反应。8例于定位当日、42例于次日接受VATS;术中按定位针指导均成功找到并切除病灶。结论 CT引导下新型肺结节定位针VATS术前定位肺小结节效果佳且安全。     

胸腔镜术前Hook-wire穿刺定位肺部单纯性磨玻璃样结节

目的探讨胸腔镜术前采用hook-wire穿刺定位肺部单纯性磨玻璃样结节的应用价值。方法 39例患者,共41个直径小于2cm的肺部pGGO病灶,行全胸腔镜下病灶切除术,术前均在DSAInnovaCT引导下采用hook-wire对病灶穿刺定位,对临床数据进行回顾性分析,对手指触诊阳性率与病灶临床因素进行相关性分析,比较手指触诊与hook-wire定位的成功率,总结hook-wire定位定位的并发症等。结果术中触诊12个病灶(29.3%)可触及并明确定位;3个病灶(7.3%)术中发现穿刺针移位;病灶的大小、深浅、病理类型、所在部位以及穿刺定位过程的时间长短,与触诊的阳性率无显著关系,39个(95.1%)病灶可通过hook-wire准确定位,与触诊比较准确性有显著差异(P<0.01);常见并发症为无症状气胸5例(12.8%),血胸2例(5.2%),严重胸痛1例(2.6%)。结论对于小于直径2cm的肺部pGGO,胸腔镜手术有必要常规进行病灶的定位,其中采用Hook-wire对病灶进行穿刺定位是一项有效、安全的技术。     

Computed tomography-fluoroscopy guided injection of cyanoacrylate to mark a pulmonary nodule for thoracoscopic resection

Background: There have been several reports regarding aids to localize small and/or deeply situated peripheral pulmonary lesions thoracoscopically. However, we have found that they were not always reliable and have attempted to use a cyanoacrylate adhesive as an alternative.Method: We injected 0.1～0.2 ml of Histoacryl® (n-butyl-2-cyanoacrylate) blue through a 22 gauge long needle to the lung parenchyma immediately beneath the pleural surface that was nearest to the target nodule. Following local anesthesia of the thoracic wall, we inserted the needle tip to the desired position under CT-fluoroscopic guidance. After retracting the syringe piston to confirm that no blood was aspirated, we injected the adhesive and immediately removed the needle.Results: The adhesive polymerized immediately after its injection into the lung parenchyma to form a hard nodule. There was no complication except mild pneumothorax and slight pain at the puncture site. The adhesive nodule measured 1.0～1.5 cm in diameter and was hard enough to be easily located thoracoscopically in all the 8 patients/9 nodules studied. The nodule was also recognizable by its blue color visible under the pleura.Conclusion: CT-fluoroscopy guided injection of Histoacryl® blue provided a reliable marker for the localization of pulmonary nodules, especially in those patients with severe anthracosis in the pulmonary parenchyma.     

胸腔镜切除术前CT引导下记忆合金定位弹簧圈精准定位肺小结节

目的 观察电视胸腔镜手术（VATS）前CT引导下肺结节记忆合金定位弹簧圈对精准定位肺小结节的价值。方法 对92例患者共102个肺小结节（直径≤ 2 cm）于VATS前行CT引导下记忆合金定位弹簧圈定位,定位后24 h内行VATS手术切除结节,观察定位效果及并发症。结果 102个肺小结节定位成功率为98.04%（100/102）,定位操作时间8~45 min,平均（17.26±5.92）min;2例2个结节VATS术中发现弹簧圈自肺组织内脱出滞留于胸壁;定位后少量气胸发生率10.78%（11/102）,少量肺泡出血发生率12.75%（13/102）,均无症状而未予处理。102个结节均经VATS成功切除,无中转开胸病例。结论 VATS术前CT引导下肺结节记忆合金定位弹簧圈可有效定位肺小结节,且安全性较好。     

肺部小结节胸腔镜术前CT引导下硬化剂定位的临床应用价值

目的 探讨肺部小结节胸腔镜术前CT引导下注射硬化剂定位的临床应用价值.方法 2010年12月至2012年1月,27例患者,检出29枚孤立性肺结节,胸腔镜术前在CT引导下注射硬化剂(医用胶)定位后成功行胸胸腔镜下肺楔形切除术.结果 CT引导下注射医用胶定位成功率100％.定位时间(6.87±6.75)min,定位后无严重并发症,29枚小结节均成功定位后行胸腔镜下肺楔形切除术,无中转开胸于术,手术后均经病理确诊.结论 CT引导下注射硬化剂(医用胶)定位方法安全、可行,效果可靠.     

Complications of thoracoscopic pulmonary resection

Thoracoscopic strategies are becoming increasingly utilized in the management of patients with thoracic disease processes, including primary pulmonary malignancy, secondary pulmonary malignancy, granulomatous lung disease, and pleural processes. Although minimally invasive approaches have been demonstrated to improve outcomes and reduce complications, as compared to the conventional approach, the prevention, early recognition, and effective management of complications after thoracoscopic pulmonary resection are still critical factors in optimizing outcomes.     

Usefulness of ultrasonically activated scalpel for pulmonary resection in video-assisted thoracoscopic surgery

We evaluated the reliability and efficacy of the ultrasonically activated scalpel (Harmonic Scalpel) for pulmonary resection in video-assisted thoracoscopic surgery (VATS). Fifty-six cases of primary or metastatic lung cancer with history of lobectomy or segmentectomy from July 2003 to June 2006 were investigated. The ultrasonically activated scalpel was used to separate aborted lobulation and segment in the surgery. The outcome of the operation using the ultrasonically activated scalpel revealed the mean operation time of 224.5 minutes and mean blood loss volume of 116.7 ml. The chest drainage catheter was removed at the postoperative day 3.4 and hospitalization lasted 10.4 days on average. By means of statistical analysis, no significant differences were noted when compared with the cases using surgical stapler to separate the lobules or segments of the lungs. Histopathological results showed destruction of alveolar structures and denaturation of cells at the cut surface of the resected lung through the use of the ultrasonically activated scalpel. This method resulted in good lung expansion and preservation of the residual lung volume. Furthermore, it prevented postoperative air leakage by appropriate treatment to the cut surfaces of the residual lung. Indeed, the method appears to be useful in the separation of lung tissues in severe aborted lobulation and segmentectomy by VATS.     

舒更葡糖钠对胸腔镜肺切除术后恢复的影响

目的：探讨舒更葡糖钠对胸腔镜肺切除术后肺部并发症（PPCs）及术后恢复的影响。
方法：选择2021年11月至2023年7月接受择期胸腔镜肺段切除术或肺叶切除术的患者263例,男112例,女151例,年龄18～64岁,BMI 18.5～28.0 kg/m²,ASAⅠ—Ⅲ级。将患者随机分为三组：舒更葡糖钠组（S组,n=88）、新斯的明组（N组,n=87）和对照组（C组,n=88）。患者术后被送至PACU,当四个成串刺激（TOF）计数为2时,S组静脉注射舒更葡糖钠2 mg/kg,N组静脉注射新斯的明0.04 mg/kg+阿托品0.02 mg/kg,C组静脉注射等容量生理盐水。记录手术结束至出院前PPCs的发生情况,记录手术结束至拔管时间、给药至四个成串刺激比值（TOFr）恢复至0.9的时间、拔管时TOFr、PACU停留时间、拔管后低氧血症（SpO₂<90%）的情况并计算拔管时肌松残余（PRNB）发生率,记录首次下床活动时间、术后48 h内镇痛泵总按压次数、有效按压次数、补救镇痛例数、临床肺部感染评分（CPIS）、术后恶心呕吐（PONV）例数、胸管总引流量、胸管留置时间和术后住院时间。
结果：与C组比较,S组PPCs发生率、拔管时PRNB和拔管后低氧血症发生率明显降低,手术结束至拔管时间、给药至TOFr恢复至0.9的时间、PACU停留时间和术后首次下床活动时间明显缩短,拔管时TOFr明显升高,CPIS评分明显降低（P<0.05）;N组手术结束至拔管时间、给药至TOFr恢复至0.9的时间、PACU停留时间明显缩短,拔管时TOFr明显升高,拔管时PRNB发生率明显降低（P<0.05）。与N组比较,S组拔管时PRNB发生率明显降低,手术结束至拔管时间、给药至TOFr恢复至0.9的时间、PACU停留时间和术后首次下床活动时间明显缩短,拔管时TOFr明显升高（P<0.05）。三组其余指标差异均无统计学意义。
结论：舒更葡糖钠在胸腔镜肺切除术后可快速拮抗残余肌松,降低PPCs和拔管时PRNB发生率,促进患者术后快速康复。     

Computed tomography-fluoroscopy guided injection of cyanoacrylate to mark a pulmonary nodule for thoracoscopic resection.

BACKGROUND: There have been several reports regarding aids to localize small and/or deeply situated peripheral pulmonary lesions thoracoscopically. However, we have found that they were not always reliable and have attempted to use a cyanoacrylate adhesive as an alternative. METHOD: We injected 0.1-0.2 ml of Histoacryl (n-butyl-2-cyanoacrylate) blue through a 22 gauge long needle to the lung parenchyma immediately beneath the pleural surface that was nearest to the target nodule. Following local anesthesia of the thoracic wall, we inserted the needle tip to the desired position under CT-fluoroscopic guidance. After retracting the syringe piston to confirm that no blood was aspirated, we injected the adhesive and immediately removed the needle. RESULTS: The adhesive polymerized immediately after its injection into the lung parenchyma to form a hard nodule. There was no complication except mild pneumothorax and slight pain at the puncture site. The adhesive nodule measured 1.0-1.5 cm in diameter and was hard enough to be easily located thoracoscopically in all the 8 patients/9 nodules studied. The nodule was also recognizable by its blue color visible under the pleura. CONCLUSION: CT-fluoroscopy guided injection of Histoacryl blue provided a reliable marker for the localization of pulmonary nodules, especially in those patients with severe anthracosis in the pulmonary parenchyma.