单操作孔全胸腔镜手术在胸部肿瘤手术中的应用分析

摘要

目的：探讨单操作孔全胸腔镜手术( single utility port video-assisted thoracoscopic surgery, SP-VATS)在胸部肿瘤手术中的临床价值。方法回顾性分析2006年11月至2013年6月在我科施行单操作孔全胸腔镜下胸部肿瘤手术95例,其中男性59例,女性36例；平均年龄56．3±20．2岁。结果全组手术均顺利完成,中转开胸4例,无手术死亡,术后无支气管胸膜瘘、大出血等严重并发症。95例胸部肿瘤手术中后纵隔肿瘤4例,前纵隔肿瘤7例,壁胸膜肿瘤4例,肺大疱9例,肺部良性肿瘤23例,肺癌48例,肺癌楔形切除40例,肺癌肺叶切除8例,肺癌楔形切除原因是高龄患者或肺功能较差不能耐受肺叶切除。本组患者术后疼痛小,尤其是咳嗽时疼痛明显减轻。手术时间(38．6±23．5) min,术中出血量(43．5±32．2) ml,胸腔闭式引流时间(2．8±2．1) d,术后住院时间为(6．5±3．3) d。结论单操作孔全胸腔镜手术时间短、创伤小、失血少、术后疼痛轻、恢复快、生活质量高、治疗疗效确切、安全可靠,初期适用于较小的纵隔肿瘤及肺楔形切除术,熟练掌握后可应用于肺癌肺叶切除术。%Objective To evaluate the effects of single utility port video-assisted thoracoscopic surgery ( SP-VATS) on thoracic tumor. Method The clinical data of 95 patients ( including 59 males and 36 females, with an age ranging from 22 to 79, mean 56. 3±20. 2) with thoracic tumor from November 2006 to June 2013 treated by SP-VATS in Shandong Tumor Hospital were retrospectively analyzed. Result No failure cases were observed, four cases were conversed to thora-cotomy. There was no perioperative death in the cohort of patients. No postoperative broncho-pleural fistula, bleeding and other serious complications. In the 95 cases of thoracic tumor surgery, there were 4 cases of posterior mediastinal tumors, 7 cases of anterior mediastinal tumors, 4 cases of parietal tumor, 9 cases of bullae, 23 cases of benign lung tumor, 48 cases of lung cancer;There were 40 cases of wedge resection, 8 cases of lung lobectomy, wedge resection of lung cancer was applied due to poor lung function in elderly patients or inadequate tolerance against lobectomy. Postoperative pain was reduced, especially for coughing pain. The averages for operation time was (38. 6±23. 5) min, for blood loss was (43. 5± 32. 2) ml, for thoracic drainage time was (2. 8±2. 1) d, and for postoperative hospital stay was (6. 5±3. 3) d. Conclu-sion SP-VATS takes less time, causes minor trauma and less blood loss, as well as less postoperative pain, thus faster recovery, higher quality of life would be expected, which is an effective, safe and reliable operation that initially suitable for smaller mediastinal tumor and pulmonary wedge resection, and can be applied to lobectomy in lung cancer when fully mastered.