胸腔镜解剖性亚肺叶切除在肺结节治疗中的应用

目的探讨解剖性亚肺叶切除治疗肺结节的指征选择、技术要点及其安全性。方法回顾性分析2017～2020年在我院行解剖性亚肺叶切除的242例ⅠA期肺癌患者临床资料,其中男81例、女161例,中位年龄57.0(50.0,65.0)岁。根据手术方式,将患者分成肺段组(n=148)、联合肺段组(n=31)、扩大肺段组(n=43)和解剖楔形组(n=20),总结各组患者术前影像学资料、手术情况及术后早期恢复情况。结果 242例患者中位病史4.0个月;胸部CT结节的中位最大径1.1 cm,81.0%的患者实性占比≤0.25;术后病理为原发肺腺癌240例;中位手术时间130.0 min,中位出血量50.0 mL,术后中位引流时间3.0 d,总住院费用(5.3±1.2)万元。组间比较,联合肺段切除手术时间明显长于肺段切除(P=0.001);解剖楔形切除组手术时间(P=0.000)、术中出血量(P=0.000)、术中淋巴结采样数量(P=0.007)、住院费用(P=0.000)均短于或少于其它组,差异有统计学意义;术后胸腔引流时间、总引流量、术后漏气和术后住院时间组间差异无统计学意义(P>0.05)。结论...

Application of thoracoscopic anatomic sublobar resection in the treatment of pulmonary nodules

Objective To investigate the surgical procedure selection,operation technique and safety of anatomic sublobar resection for pulmonary nodules.Methods The clinical data of 242 patients with clinical stageⅠA lung cancer who underwent anatomic sublobar resection in our hospital between 2017 and 2020 were retrospectively analyzed.There were 81 males and 161 females with a median age of 57.0(50.0,65.0)years.They were divided into 4 groups according to the surgical methods,including a segmentectomy group(n=148),a combined segmentectomy group(n=31),an enlarged segmentectomy group(n=43)and an anatomic wedge resection group(n=20).The preoperative CT data,operation related indexes and early postoperative outcomes of each group were summarized.Results The median medical history of the patients was 4.0 months.The median maximum diameter of nodule on CT image was 1.1 cm,and the consolidation/tumor ratio(CTR)was≤0.25 in 81.0%of the patients.A total of 240 patients were primary lung adenocarcinoma.The median operation time was 130.0 min,the median blood loss was 50.0 mL,the median chest drainage time was 3.0 d,and the hospitalization cost was(53.0±12.0)thousand yuan.The operation time of combined segmentectomy was longer than that of the segmentectomy group(P=0.001).The operation time(P=0.000),intraoperative blood loss(P=0.000),lymph nodes dissected(P=0.007)and cost of hospitalization(P=0.000)in the anatomic wedge resection group were shorter or less than those in the other three groups.There was no significant difference in the drainage time,total drainage volume,air leakage or postoperative hospital stay among the four groups(P>0.05).Conclusion The combined application of segmentectomy and wedge resection technique provides a more flexible surgical option for the surgical treatment of early lung cancer with ground glass opacity as the main component.