单孔胸腔镜联合三维血管支气管CT成像在解剖性肺段切除中的应用

Application of single-port thoracoscopy combined with three-dimensional CT bronchography and angiography in anatomical segmentectomy of lungs

  • 摘要:
      目的  探讨单孔胸腔镜联合三维血管支气管CT成像(3D-CTBA)在解剖性肺段切除中的应用价值。
      方法  选取行单孔胸腔镜解剖性肺段切除术的46例肺部小结节患者为研究对象,对其临床资料进行回顾性分析。
      结果  所有患者术前均行3D-CTBA,均在单孔胸腔镜下行肺段切除术,无中转开胸,无扩大肺叶切除,无围术期死亡。手术时间为(139.3±32.5)min,术中出血量为(84.5±45.3)mL,术后胸管拔管时间为(5.5±1.3)d,术后住院时间为(7.1±2.8)d,淋巴结清扫数目为(10.2±3.4)枚。术后病理为原发性肺腺癌39例,转移性癌3例,肉芽肿4例。术后2例肺漏气大于5 d,经持续引流后好转;2例肺部感染,抗感染治疗后好转;3例心律失常。
      结论  单孔胸腔镜联合3D-CTBA解剖性肺段切除术安全性、可行性较好,有利于患者快速康复。

     

    Abstract:
      Objective  To investigate the application value of single-port thoracoscopy combined with three-dimensional CT bronchography and angiography (3D-CTBA) in anatomical segmentectomy of lungs.
      Methods  A total of 46 patients with pulmonary nodules who underwent single-port thoracoscopic anatomical segmentectomy and their clinical data were retrospectively analyzed.
      Results  All patients underwent 3D-CTBA before operation, and segmentectomy was performed under single-port thoracoscopy without thoracotomy, extended lobectomy and perioperative death.The operative time was (139.3±32.5) min, the intraoperative blood loss was (84.5±45.3) mL, the postoperative chest tube extubation time was (5.5±1.3) days, the postoperative hospital stay was (7.1±2.8) days and the number of lymph nodes dissected was (10.2±3.4).Postoperative pathology showed primary lung adenocarcinoma in 39 cases, metastatic carcinoma in 3 cases and granuloma in 4 cases. After operation, two patients had pulmonary air leakage more than 5 days, which was improved after continuous drainage; two cases had pulmonary infection, and were improved after anti-infection treatment; arrhythmia occurred in 3 cases.
      Conclusion  Single-port thoracoscopy combined with 3D-CTBA anatomical segmentectomy is safe and feasible, which is conducive to the rapid recovery of patients.

     

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