双孔法全胸腔镜肺叶切除术治疗肺良性疾病192例分析

摘要

目的 探讨双孔法全胸腔镜肺叶切除术治疗肺良性疾病的安全性和有效性.方法 2011年2月～2015年10月我科采用双孔法全胸腔镜肺叶切除手术治疗肺良性疾病192例,切口为一个操作孔和一个观察孔,观察孔替代操作孔,应用双关节手术器械双孔双手同向双交叉操作,不撑开或牵拉肋骨,进行解剖性肺叶切除.结果 7例(3.6％)因为胸腔内粘连重,叶间裂分化差或肺门血管迂曲生长出血改为传统三孔法VATS.手术时间(115.6±87.1) min(86 ～ 281 min),术中出血量(184.3±71.8)ml(50 ～374 ml).术后胸腔引流管放置时间(6.1±4.8)d(2～15 d).术后住院(9.3±4.6)d(5～16 d).无围手术期死亡,20例术后并发症(10.4％):术后肺持续漏气12例,肺部感染5例,切口感染3例,均经保守治疗治愈.192例随访平均22.3月(3～40个月),均恢复良好.结论 双孔法全胸腔镜肺叶切除术是治疗肺良性疾病的一种安全有效的方法.%Objective To evaluate the safety and efficacy of dual-port complete video-assisted thoracoscopic surgery (cVATS) for lobectomy in the management of pulmonary benign diseases.Methods Between February 2011 and October 2015,a total of 192 patients with pulmonary benign disease underwent dual-port cVATS for lobectomy in our hospital.All the resections were carried out by pure thoracoscopic procedures using two ports,one working port and one observing port,which could replace each other.During the anatomical lobectomy operation,the double joint surgical instruments were used by double hands for cross performance,without distracting or pulling the ribs.Results Conversion to traditional tri-port cVATS occurred in 7 patients (3.6％) due to severe adhesion,poor differentiation of the fissure and the proliferation of tortuous vessels at the hilus.The mean time for dual-port cVATS was (115.6 ± 87.1) min (range,86-281 min),during which,a mean of (184.3 ± 71.8) ml blood loss (range,50-374 ml) was collected.The mean chest tube duration was (6.1 ± 4.8) days (range,2-15 days) and the mean postoperative hospital stay was (9.3 ± 4.6) days (range,5-16 days).No mortality or severe complications occurred perioperatively.However,complications occurred in 20 cases (morbidity rate:10.4％),including 12 cases of persistent air 1eak,5 cases of pneumonia and 3 cases of incision infection.Follow-up for an average of 22.3 months (range,3-40 months) found all patients recovered well.Conclusion Dual-port cVATS is safe and effective for lobectomy in patients with pulmonary benign diseases.