无抓持整块纵隔淋巴结清扫在单孔胸腔镜肺癌手术中的应用

摘要

Objective To analyze the safety, feasibility and operative technique details of non-grasping en bloc mediastinal lymph nodes dissection technique in uniportal video-assisted thoracic surgery(VATS) for lung cancer.Methods From April, 2014 to March, 2015,46 patients with lung cancer received non-grasping en bloc mediastinal lymph nodes dissection after uniportal VATS lobectomy.Clinical data of the cases were analyzed retrospectively.There were 19 males and 27 females.The age was(57.2 ± 9.0) (38-73) years.The first 6 cases were performed in the lateral decubitus position while the later 40 cases were all performed in the semiprone position.Results All cases accepted uniportal VATS non-grasping en bloc mediastinal lymph nodes dissection successfully.Arm fatigue of surgeon and assistant was obviously relieved when the patient was placed in the semiprone position.The thoracic drainage time was(3.2 ± 2.1) (1-12)days and the postoperative length of hospital-stay was(6.0 ± 4.5) (2-27) days.The number of dissected mediastinal lymph nodes stations was (4.3 ± 0.8) (3-6)and the number of dissected mediastinal lymph nodes was (11.8 ± 4.9) (4-30).There were 42 cases with stage No , lease wit stage N1, and 3 cases with stage N2 in pathological examination.Five patients developed minor postoperative complications.No perioperative death occurred.Conclusion Uniportal VATS non-grasping en bloc mediastinal lymph nodes dissection for lung cancer was safe and feasible, which could decrease the interference of the instruments and help to keep the surgical field clear.Non-grasping en bloc mediastinal lymph nodes dissection would be performed more smoothly in the semiprone position with less damage to lung and better ergonomics.%目的 总结单孔胸腔镜肺癌手术中无抓持整块纵隔淋巴结清扫的安全性、可行性及技术要点.方法 回顾性分析2014年4月至2015年3月顺利完成单孔胸腔镜肺叶切除后进行无抓持整块纵隔淋巴结清扫的46例肺癌患者的临床资料.男19例,女27例;年龄平均(57.2±9.0)岁.前6例采用侧卧位,后40例采用半俯卧位.结果 46例完成单孔胸腔镜肺叶切除患者均使用无抓持技术顺利完成纵隔淋巴结清扫.半俯卧位下操作时,术者及助手上臂疲劳明显减轻.清扫纵隔淋巴结(4.3±0.8)组,(11.8±4.9)个.术后放置胸管(3.2±2.1)天,术后住院(6.0±4.5)天.术后病理分期示N0期42例,N1期1例,N2期3例.全组无围术期死亡,无严重并发症发生.轻微并发症5例,均经保守治疗后痊愈.结论 单孔胸腔镜手术中使用无抓持技术进行纵隔淋巴结清扫安全可行,能减少器械的相互干扰并保证术野的清晰干净.半俯卧位下进行操作更能体现此技术的优越性,同时能减少对肺的牵拉损伤,更符合人机工程学.