单一部位切口胸腔镜肺叶切除术的初步体会

摘要

目的：探讨单一部位切口胸腔镜肺叶切除术的可行性及安全性。方法2014年8～12月，全麻双腔气管插管下行单一部位切口胸腔镜肺叶切除术4例（肺癌2例，支气管扩张1例，慢性肺脓肿1例），于腋前线与腋中线间第5或第6肋间做切口长4～5 cm，置入10 mm 30°胸腔镜和器械，行右上肺切除1例，右中肺切除1例，左上肺切除1例，左下肺切除1例。结果无中转开胸或增加辅助切口。手术时间分别为210、175、145、205 min，平均183 min；出血量分别为100、200、50、300 ml，平均162 ml；术后住院时间分别为10、8、12、12 d，平均10．5 d。4例分别随访6、8、6、3个月，无复发和转移。结论单一部位切口胸腔镜肺叶切除术安全、可行。%Objective To explore the feasibility and safety of single-site incision video-assisted thoracoscopic surgery (VATS)in pulmonary lobectomy. Methods A total of 4 cases of pulmonary lobectomy underwent single-site incision VATS under double lumen endotracheal intubation general anesthesia in our hospital from August to December 2014.The incision 4 -5 cm in length was cut between the anterior axillary line and the midaxillary line in the fifth or sixth intercostal space,and a 10 mm 30°thoracoscope and instruments were inserted through the incision.There are two patients with lung cancer,one with bronchiectasis and one with lung abscess.The surgeries included lobectomies of right upper lobe (n =1 ),right middle lobe (n =1 ),left upper lobe (n =1 ),and left lower lobe (n =1 ). Results There was no conversion to thoracotomy or requirement for additional assistance incision.The operative time was 210,175,145 and 205 min,respectively,with a mean of 183 min.The blood loss was 100,200,50 and 300 ml, respectively,with a mean of 162 ml.The postoperative hospital stay was 10,8,12 and 12 d,respectively,with a mean of 10.5 d. The 4 patients were followed for 6,8,6,and 3 months,respectively,without recurrence or metastasis. Conclusion Single-site incision video-assisted thoracoscopic lobectomy is safe and feasible.