单孔全胸腔镜肺叶切除术治疗非小细胞肺癌的初步探索

摘要

Objective To investigate the safety and feasibility of single‐port total thoracoscopic lo‐bectomy in treating non‐small cell lung cancer . Methods A retrospective study was conducted on 20 pa‐tients with non‐small cell lung cancer (NSCLC) from May 2014 to July 2014 . There were 12 male pa‐tients and 8 female patients . The average age was (62 .3 ± 16 .5) year old . All patients underwent lo‐bectomy ,including 5 cases left upper lobe ,4 cases left lower lobe ,4 cases right upper lobe ,3 cases right middle lobe ,and 4 cases right lower lobe . Postoperative pathology demonstrated 17 cases of adenocarci‐noma ,2 cases of squamous carcinoma ,and 1 case of carcinoid tumor . Patients with TNM stages 0 ,Ⅰ a ,Ⅰ b ,Ⅱ a ,Ⅱ b ,and Ⅲ a were 1 ,7 ,5 ,1 ,3 ,and 3 cases . ResuIts All participants underwent surgeries successfully . The incision was located at the 4th or 5th intercostal space along the anterior axillrey line with a length of 3 .5~4 .5 cm . The average operative time was (217 .0 ± 46 .0) min ,and the average intraoperative blood loss was (92 .5 ± 50 .3) mL . The average postoperative total volume of drainage was (732 .2 ± 413 .9) mL ,and the average chest drainage duration was (4 .3 ± 1 .7) d . The average postopera‐tive one‐day pain visual analogue scale (POP‐VAS) was (3 .9 ± 0 .8) ,and the average postoperative hospi‐tal stay was (6 .8 ± 3 .6) d . On the average ,the total lymph node harvests were (24 .3 ± 11 .7) ,the medi‐astinal lymph node harvests were (16 .3 ± 9 .5) ,and the dissection of mediastinal lymph node groups were (4 .5 ± 1 .0) . All cases underwent single‐port total thoracoscopic lobectomy without any other ports and conversion to open thoracotomy . There were no death cases during perioperative period ,and one case with pulmonary infection was discharged after treatment . ConcIusion Single‐port total thoracoscopic lobectomy for treating NSCLC is feasible and it deserves clinical popularization .%目的：探讨单孔全胸腔镜肺叶切除手术治疗非小细胞肺癌的安全性、可行性。方法回顾性分析行单孔全胸腔镜肺叶切除治疗的20例非小细胞肺癌患者的临床资料。结果全组均顺利手术，手术切口选在腋前线第4或第5肋间，长约3．5～4．5cm，无增加切口或改开胸手术。术后出现肺部感染1例，经治疗后康复出院。全组手术时间（217．0±46．0）min ，术中失血量（92．5±50．3）mL ，术后总引流量（732．2±413．9）mL ，术后胸管留置时间（4．3±1．7）d，术后第1d疼痛视觉模拟评分（3．9±0．8）分，术后住院时间（6．8±3．6）d；全组平均淋巴结清扫总数（24．3±11．7）枚，纵隔淋巴结清扫站数（4．5±1．0）站，纵隔淋巴结清扫数（16．3±9．5）枚。结论单孔全胸腔镜肺叶切除术治疗非小细胞肺癌安全可行，值得临床推广。