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全胸腔镜支气管袖式成形肺癌切除的流程设计与优化

Improving the Procedures of Video-assisted Thoracoscopic Surgery Bronchial Sleeve Lobectomy for Lung Cancers

  • 摘要: 目的 总结临床实践中对全胸腔镜支气管袖式成形肺癌切除手术流程的设计与优化。 方法 2010年12月至2012年7月,我科共完成全胸腔镜支气管袖式成形肺癌切除术11例,包括右肺上叶切除7例、左肺上叶切除3例、左肺下叶切除1例。其间,分别对手术切口、肺门结构游离及支气管吻合方法进行了设计与优化。左右侧手术切口不同,采用"镂空"流程切除病肺,通过连续吻合重建支气管。 结果 手术失血量(中位数)200 mL(50~400 mL),支气管吻合及总手术时间(中位数)分别为50 min(35~60 min)及235 min(200~320 min)。清扫淋巴结总数(中位数)为15枚(8~28枚)。全组病例无中转开胸及输血。胸腔中位引流时间3 d(2~12 d)。纤支镜检查证实吻合口均通畅。1例患者发生支气管胸膜瘘并于术后49 d因呼吸道出血死亡,两例患者并发肺炎,术后住院时间(中位数)为8 d(8~49 d)。10例患者随访3月均未发现吻合口狭窄。 结论 全胸腔镜支气管袖式成形肺癌切除手术安全可行。实践中不断设计和优化手术流程,可为这一复杂手术的推广创造条件。

     

    Abstract: Objective To modify and improve the procedures of video-assisted thoracoscopic surgery (VATS) bronchial sleeve lobectomy for lung cancers. Methods From December 2010 to July 2012, 11 patients with non-small cell lung cancers underwent VATS bronchial sleeve lobectomy in our department, which included 7 cases of right upper lobectomy, 3 cases of left upper lobectomy and 1 case of left lower lobectomy. We modified the surgical procedures in relation to the distribution of VATS ports, the techniques of dissecting hilar structures and the method of bronchial reconstruction. The position of incisions for the left side differed from the right side. The lobe was resected with the technique of "hollow out" and the bronchus was reconstructed using a running prolene stitch. Results Blood loss of these 11 patients ranged from 50-400 (median 200) mL. The operations were completed within 200-320 (median 235) minutes and the duration needed for bronchial reconstruction ranged from 35 to 60 (median 50) minutes. A total of 8-28 (median 15) lymph nodes were dissected. There was no conversion to thoracotomy or blood transfusion. Chest drainage tubes were removed within 2-12 (median 3) days after surgery. The patency of bronchial anastomosis was confirmed by bronchoscopy. Postoperative complications occurred in three patients, which included one case of bronchial pleural fistula (BPF) and two cases of pneumonia. The patient suffered from BPF died 49 days after surgery from intrabronchial bleeding. The postoperative hospital stay of those patients ranged from 8 to 49 (median 8) days. The reconstructed bronchus continued to work well during the three month follow-up visits. Conclusion VATS bronchial sleeve lobectomy is feasible and safe. The modifications of the surgical procedures may promote the use of this complex operation.

     

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