目的

探究非插管单孔胸腔镜(non-intubated uniportal video-assisted thoracic surgery,NI UVATS)袖式肺叶切除术的可行性,并总结其手术技巧与临床疗效。

方法

回顾性分析2019年3月至2023年7月上海肺科医院胸外科同一手术团队施行的18例NI UVATS袖式肺叶切除术患者的病历资料,包括13例肺鳞癌、2例肺腺癌、1例腺样囊性癌以及2例类癌。

结果

18例均顺利完成根治性切除及支气管吻合手术,无中转开胸的情况。平均手术时长为118.33±19.17 min,平均清扫淋巴结站数5.71±1.69(其中第7组淋巴结在所有病例中均被清扫)枚,平均清扫淋巴结数量13.24±5.88个。手术当日引流量均值为324.71±155.17 ml,术后平均住院时长为4.22±1.48 d。在15例确诊为恶性肿瘤的患者中,8例接受了术后化疗。术后1年,2例患者分别出现肝转移和脑转移,经化疗联合免疫治疗后,肿瘤得到良好控制;术后1.5年,1例鳞癌患者发生局部复发,经右上肺袖式肺叶切除术后联合化疗与免疫治疗,肿瘤控制效果理想。术后随访时间平均为25.7±10.7个月,其间死亡率为0。

结论

在经验丰富的UVATS外科医师与麻醉医师紧密协作下,针对经过严格筛选的患者实施NI UVATS袖式切除术具备切实可行性。

Objective

To explore the feasibility of non-intubated uniportal video-assisted thoracic surgery(NI UVATS) sleeve lobectomy and summarize the surgical techniques and clinical outcomes.

Methods

From Mar. 2019 to Jul. 2023, a total of 18 non-intubated uniportal VATS sleeve lobectomy were performed by the single surgical team at the Thoracic Surgery Department of the Shanghai Pulmonary Hospital.

Results

All 18 patients successfully underwent radical resection and bronchial anastomosis. No patient was converted to thoracotomy during the entire operation.The 18 cases comprised lung squamous cell carcinoma (n=13), lung adenocarcinoma (n=2), adenoid cystic carcinoma (n=1), andcarcinoid tumor(n=2). The average operation time was 118.33±19.17 minutes. The average number of lymph node stations removed was 5.71±1.69, including station seven in all cases, and the median number of lymph nodes removed was 13.24±5.88.On the day of surgery, the drainage volume was 324.71±155.17 ml. The mean postoperative hospital stay was 4.22±1.48 days.Eight of the 15 patients diagnosed with malignancy received postoperative chemotherapy. One year after the operation, two patients experienced tumor metastasis. These two patients received postoperative chemotherapy combined with immunotherapy and achieved good tumor control.1.5 years after the operation,a local recurrence in a patient with a squamous cell carcinoma. The postoperative follow-up time was 25.7±10.7 months. The mortality was zero.

Conclusions

Non-intubated uniportal VATS sleeve resections on selected patients are feasible procedures in hands of experienced uniportal VATS surgeons,teamed up with experienced anesthetists.