单孔全胸腔镜解剖性肺段切除术治疗早期非小细胞肺癌

目的总结单孔全胸腔镜解剖性肺段切除术治疗早期非小细胞肺癌(NSCLC)的临床经验。 方法回顾性分析2014年5月至2015年3月在福建医科大学附属协和医院胸外科行单孔全胸腔镜解剖性肺段切除术治疗27例早期NSCLC患者的临床病例资料。采用双腔气管内插管、健侧单肺通气，于腋前线第4或第5肋间做一个长4～5 cm的手术切口，先完成解剖性肺段切除，如术中病理证实为NSCLC则进一步行纵隔淋巴结清扫或采样。主要观察指标包括围手术期资料(手术时间、出血量、引流管放置时间、住院时间等)、肿瘤手术效果(淋巴结切除总数、纵隔淋巴结切除站数、纵隔淋巴结切除数)及术后疼痛评分。 结果所有病例均在单孔全胸腔镜下完成手术，无增加辅助腔镜切口、无中转开胸病例。无围手术期死亡病例，有3例患者发生并发症(肺部感染2例，心律失常1例)，经治疗后均痊愈，并发症发生率为11.1%。27例早期NSCLC患者的平均手术时间(192.2±56.1)min，术中出血量(83.8±50.5)ml，术后拔管时间(4.5±1.3)d，术后住院时间(6.2±2.7)d，术后疼痛VAS评分(3.4±0.9)分。手术效果显示：每例患者平均淋巴结切除总数(13.7±5.3)枚，纵隔淋巴结切除总数(9.5±4.3)枚，纵隔淋巴结切除站数(5.6±1.3)站。 结论在有丰富腔镜手术经验的治疗中心，单孔全胸腔镜解剖性肺段切除术治疗早期NSCLC在技术上是安全可行的，是一种更为微创的手术方法。

Single-port thoracoscopic anatomic segmentectomy for early-stage non-small cell lung cancer

ObjectiveTo summarize the clinical experience of single-port thoracoscopic anatomic segmentectomy for early-stage non-small-cell lung cancer(NSCLC). MethodsThe clinical data of 27 patients undergoing single-port thoracoscopic anatomic segmentecomy for early-stage NSCLC in Department of Thoracic Surgery, Union Hospital affiliated to Fujian Medical University between May 2014 and March 2015 were retrospectively analyzed. A double lumen endotracheal tube was input, and the contralateral one-lung ventilated. A 4-5 cm incision was put on the anterior axillary line in the 4th or 5th intercostal space. Anatomic segementecomy was carried out firstly, and mediastinal lymph node dissection or sampling was executed when NSCLC was confirmed by intraoperative frozen pathology. The outcomes included perioperative parameters (operative time, volume of blood loss, duration of drainage, length of postoperative hospital stay, etc.), oncological results (total number of lymph node resection, total number of mediastinal lymph node resection, and number of stations of mediastinal lymph node resection), and pain score. ResultsAll cases of single-port thoracoscopic surgery were completed, without adding auxiliary incision or converting to thoracotomy. There was no case of perioperative death, while there were 3 cases of complications (2 cases of pulmonary infection, and 1 case of arrhythmia), with the prevalence of complications of 11.1%. All cases of complications were cured. The mean operative time was (192.2 ± 56.1) min, the volume of blood loss was (83.8 ± 50.5) ml, the duration of drainage was (4.5±1.3) d, the length of postoperative hospital stay was (6.2±2.7) d, and the postoperative pain VAS score was (3.4 ± 0.9). The total number of lymph node dissection was (13.7±5.3), the total number of mediastinal lymph node dissection was (9.5 ± 4.3), and the number of stations of mediastinal lymph node dissection was (5.6±1.3). ConclusionIn an center with extensive experience of thoracoscopic surgery, the single-port thoracoscopic anatomic segmentectomy for early-stage NSCLC is technically feasible and safe, and is a more minimally invasive surgical approach.