全胸腔镜支气管袖式/成形肺叶切除治疗中央型肺癌120例

目的探讨胸腔镜支气管袖式/成形肺叶切除治疗中央型肺癌的安全性、有效性。方法2016年4月~2019年8月我院行胸腔镜支气管袖式/成形肺叶切除治疗中央型肺癌120例,采用三孔法,先行系统性淋巴结清扫,然后行解剖性肺叶切除,最后行支气管切除吻合。结果110例完成全胸腔镜支气管袖式/成形肺叶切除(支气管袖式切除86例,支气管楔形切除成形24例);10例中转开胸(8.3%):肺门叶间淋巴结钙化4例,肿瘤侵犯肺动脉干4例(2例中转为左全肺切除),术中大出血2例。手术时间115~440 min,中位数210 min;出血量50~1000 ml,中位数200 ml。术后平均带管5.8 d(2~34 d),平均住院6.6 d(3~35 d)。术后病理:非小细胞不明类型肺癌2例,鳞癌91例,腺癌13例,混合癌3例(鳞癌为主),神经内分泌癌2例,腺样囊性癌、肉瘤样癌、类癌、肺母细胞瘤、黏液表皮样癌各1例,小细胞肺癌4例。无围手术期死亡,3级以上并发症(Clavien分级)11例(9.2%),包括肺部感染支气管镜吸痰4例(2例呼吸衰竭经历ICU过渡治疗),胸壁皮下气肿行胸腔闭式引流6例,支气管吻合口漏二次手术1例。新辅助化疗后19例中,2例发生3级以上术后并发症(均为皮下气肿置管引流)。113例随访1~41个月,中位随访时间20个月,非肿瘤死亡1例,全身广泛转移死亡11例,Kaplan-Meier生存分析1、2、3年累积生存率分别是98.9%、90.7%、85.4%。结论全胸腔镜支气管袖式/成形肺叶切除治疗包含部分局部晚期的中央型肺癌安全有效,新辅助化疗不额外增加手术风险,值得临床推广。

Video-assisted Thoracoscopic Bronchus Sleeve/Reconstruction Lobectomy in Patients With Central Lung Cancer:Experience of 120 Patients

Objective To evaluate the efficacy of video-assisted thoracoscopic bronchus sleeve/reconstruction lobectomy in the management of central lung cancer.Methods We retrospectively reviewed 120 patients diagnosed as central lung cancer underwent surgery in our hospital between April 2016 and August 2019.The thoracoscopic resection was performed with the"three-port approach"method.The mediastinal and hilar lymph nodes resection was conducted firstly,followed with anatomical lobectomy,and at last the bronchial sleeve resection and anastomosis were performed.Results Among these patients,110 patients underwent complete thoracoscopic bronchus sleeve/reconstruction lobectomy and 10 patients were converted into open procedure.The reasons of conversion to open procedure included lymph node calcification(n=4),truncus pulmonalis invasion(n=4),and intraoperative bleeding(n=2).The operation time was 115-440 min(median,210 min).The bleeding volume was 50-1000 ml(median,200 ml).The mean value of tube drainage time and hospital stay were 5.8 d(range,2-34 d)and 6.6 d(range,3-35 d),respectively.The pathological outcomes included non-small cell lung cancer(classification unable,n=2),squamous cell lung cancer(n=91),adenocarcinoma lung cancer(n=13),mix type lung cancer(n=3),neuroendocrine lung cancer(n=2),small cell lung cancer(n=4),and others(n=5).Perioperative death was not observed.Perioperative complications with Clavien grade≥3 were observed in 11 patients,including 4 cases of bronchoscopic sputum aspiration(2 cases of respiratory failure undergoing ICU transitional treatment),6 cases of chest wall subcutaneous emphysema with closed thoracic drainage,and 1 case of secondary operation for bronchial anastomotic leakage.Among 19 cases undergoing neoadjuvant chemotherapy,2 cases had postoperative complications(all of them were subcutaneous emphysema drainage).A total of 113 cases were followed up for 1-41 months,the median follow-up time was 20 months.There were 1 case died of non-tumor and 11 cases died of general metastasis.The 1,2 and 3-year cumulative survival rates of Kaplan-Meier survival analysis were 98.9%,90.7%and 85.4%,respectively.Conclusions Video-assisted thoracoscopic bronchus sleeve/reconstruction lobectomy is a safe and effective treatment for some locally central lung cancer.Neoadjuvant chemotherapy does not increase the risk of operation.It is worthy of clinical promotion.