3D-CTBA指导下单孔胸腔镜精准肺亚段切除术外科临床应用初步结果
Primary clinical application and initial results of 3D-CTBA-guided uni-portal video-assisted thoracoscopic precision pulmonary sub-segmentectomy
陆军 1李宛霖 1孔祥龙 1徐世东 1徐海1
作者信息
- 1. 哈尔滨医科大学附属肿瘤医院胸外科,黑龙江哈尔滨 150081
- 折叠
摘要
目的 评估三维计算机断层支气管血管成像(three dimensional computed tomography bronchog-raphy and angiography,3D-CTBA)指导下单孔胸腔镜肺亚段切除术治疗肺部小结节的安全性和可行性.方法 对哈尔滨医科大学附属肿瘤医院胸外科2020年10月～2022年9月完成的30例单孔胸腔镜肺亚段切除术病例进行回顾性分析,包括其围术期临床特点和短期预后.所有患者均在术前行3D-CTBA.结果 30例患者均接受了单孔胸腔镜肺亚段切除术,无中转开胸,1例患者因切缘不足改行肺叶切除,1例患者因淋巴结钙化术中失血500 mL,无围术期死亡.平均切缘(27.8±8.0)mm,平均手术时间(203.8±57.5)min,术中失血50 mL(30～500 mL).术后并发症:延长漏气大于3天者2例,肺炎1例,心律失常2例,肺不张1例.术后病理:原位腺癌1例,微浸润腺癌10例,浸润性非黏液腺癌17例,良性病变2例.平均随访(19.4±7.1)月,30例患者均无复发及转移.结论 3D-CTBA指导下单孔胸腔镜肺亚段切除术安全可行,肿瘤学疗效满意,可用于治疗肺部小结节.
Abstract
Objective To assess the safety and feasibility of three-dimensional computed tomo-graphy bronchography and angiography(3 D-CTBA)-guided uni-portal video-assisted thoraco-scopic sub-segmentectomy in the treatment of pulmonary small nodules.Methods Data of 30 patients who received uni-portal video-assisted thoracoscopic sub-segmentectomy in Harbin Medical University Cancer Hospital from October 2020 to September 2022 were retrospectively analyzed,including the perioperative clinical characteristics and short term prognosis.3D-CT-BA was performed for every patient before surgery.Results All the 30 patients were success-fully performed by use of uni-portal video-assisted thoracoscopic sub-segmentectomy without conversion to thoracotomy.One patient was converted to lobectomy due to insufficient safe mar-gin,one patient lost 500 mL of blood intraoperatively due to lymph node calcification;No peri-operative mortality occurred.The surgical margin width was(27.8±8.0)mm;The mean oper-ative time was(203.8±57.5)min.The hemorrhage was 50 mL(30-500 mL)o Postoperative complications;Prolonged air leak＞3 d in 2 cases,pulmonary infection in 1 case,arrhythmia in 2 cases,and atelectasis in 1 case.Postoperative pathological examinations showed adenocar-cinoma in situ(AIS)in 1 patient,microinvasive adenocarcinoma in 10 patients,invasive non-mucinous adenocarcinoma in 17 patients,and benign pulmonary disease in 2 patients.The mean followed up was(19.4±7.1)months,all the 30 patients survived without tumor,no one showed metastasis or recurrence.Conclusion 3D-CTBA-guided uni-portal video-assisted tho-racoscopic sub-segmentectomy is a safe and feasible technique with satisfied oncologic results,which can be used in the treatment of pulmonary small nodules.
关键词
亚段/肺亚段切除术/单孔胸腔镜/三维重建/肺结节/早期肺癌Key words
sub-segment/pulmonary sub-segmentectomy/uni-portal video-assisted thoracos-copy/three-dimensional reconstruction/pulmonary nodule/early-stage lung cancer引用本文复制引用
出版年
2024
NETL
NSTL
万方数据