目的 总结胸腔镜肺联合亚段切除术(combined subsegmentectomy,CSS)的临床应用经验.方法 回顾性分析2018年5月-2022年7月安庆市立医院行胸腔镜CSS 76例患者的临床资料,其中男22例、女54例,年龄27.0～76.0(54.3±10.5)岁.所有患者术前行胸部薄层CT扫描、血管支气管三维重建.采用改良膨胀-萎陷法或荧光胸腔镜系统显示段间平面.结果 76例手术共切除肺结节86枚,1例左上肺S1+2c+S4a,1例右上肺S2b+S3a,1例右上肺S1b+S3b,均因切缘不足,进一步行肺叶切除;1例左上肺S1+2+S3a,因残留肺不张,进一步行左上肺固有段切除;1例左上肺S1+2c+S3a,因B3b+c损伤,进一步行左上肺固有段切除,其余均按规划完成手术.全组手术时间 90.0～350.0(174.9±53.2)min,术中出血量 50.0(20.0,50.0)mL,术后住院时间 6.0(5.0,7.0)d.术后肺部感染9例,咯血3例,肺漏气时间＞3 d4例,气胸1例,胸腔积液1例,心肌梗死1例,均治愈后出院,无围手术期死亡.结论 胸腔镜CSS相对复杂,术前三维重建规划、术中精细操作,技术上安全可行.

目的:探讨全胸腔镜下解剖性肺段切除术治疗早期非小细胞性肺癌(NSCLC)的学习曲线.方法:收集2018年1月～2020年3月本院60例行全胸腔镜下解剖性肺段切除术的早期NSCLC患者的临床资料,进行回顾性分析,按行手术的时间先后次序将患者依次分成A、B、C、D四组,各15例,分析比较各组一般资料(包括年龄、性别、肿瘤部位、肿瘤大小、操作孔数量),以及各组手术时间、术中出血量、中转开胸率、术后住院时间、术后并发症、淋巴结清扫站数及个数、术后胸管引流时间,比较不同时间的手术效果,绘制学习曲线,用累积求和法分析跨越学习曲线所需要积累的最低手术例数.结果:各组在性别、年龄、肿瘤部位、肿瘤大小上均无明显差异;A组手术时间明显长于B组,B组手术时间明显长于C组,而C组和D组手术时间无明显差异;A组术中出血量明显多于B组,B组术中出血量明显多于C组,而C组和D组术中出血量无明显差异;各组在中转开胸率、术后住院时间、术后并发症、淋巴结清扫站数及个数、术后胸管引流时间上均无明显差异;在以手术时间与术中出血量为纵坐标的学习曲线中,累积求和法结果显示,当CUSUM值为0时,对应的病例数均为30例.结论:全胸腔镜下解剖性肺段切除术治疗早期NSCLC的学习曲线约为30例.

目的:分析剑突下切口胸腔镜手术治疗前纵隔肿瘤的临床价值.方法:选取2018年6月—2019年12月我院胸外科收治的前纵隔肿瘤患者15例,按照手术方式不同随机分为对照组(行单侧胸腔镜手术)6例和观察组(行剑突下胸腔镜手术)9例.对照组采用经侧胸入路胸腔镜手术方式,观察组采用剑突下入路胸腔镜手术方式.比较两组患者手术时间、术中出血量、术后总引流量、胸引流管保留时间、疼痛评分的差异.结果:两组患者出血量、术后总引流量、胸引流管保留时间比较,差异均无统计学意义(P>0.05);观察组手术时间长于对照组,疼痛评分低于对照组,差异有统计学意义(P<0.05).结论:经剑突下入路胸腔镜前纵隔肿瘤切除术具有良好的手术视野,充分引流对侧胸腔内积液,减轻疼痛,完整切除前纵膈肿瘤组织.但本次观察例数较少,还需进一步证实.

Background Minimally invasive Ivor Lewis esophagectomy (MIILE) is increasingly being used in the treatment of middle or lower esophageal cancer. Hand-sewn purse-string stapled anastomosis is a classic approach in open esophagectomy. However, this procedure is technically difficult under thoracoscopy. The hardest part is delivering the anvil into the esophageal stump. Herein, we report an approach to performing this step under thoracoscopy. Methods A total of 257 consecutive patients who underwent MIILE between April 2013 and July 2017 were analyzed retrospectively. The operator hand sewed the purse string using silk thread under thoracoscopy, and the 25-mm circular stapler was passed through the anterior axillary line at the fourth intercostal space to finish the side-to-end gastroesophageal anastomosis. Patient demographics, intraoperative data, postoperative complications were evaluated. Results The mean operative time, thoracoscopy time, and anvil fixation time was 307.0 ± 34.3, 155.4 ± 21.5, and 7.1 ± 1.6 minute, respectively. The anastomotic leak and anastomotic stricture occurred in 6.6% (17 of 257) and 3.9% (10 of 257) of patients, respectively. There was no intraoperative death; one case was death of acute respiratory distress syndrome (ARDS) for conduit gastric leakage on the 21st postoperative day. Conclusion Using the hand-sewn purse-string stapled anastomotic technique for MIILE is feasible and relatively safe in patients with middle or lower esophageal cancer.

Objective To explore the feasibility and safety of uniportal video-assisted thoracoscopic surgery (VATS) in the treatment of lung diseases.Methods 69 patients with pulmonary diseases were underwent uniportal VATS,29 cases of lobectomy and 40 cases of partial lung resection,including 8 kinds of diseases,such as lung cancer,pulmonary sequestration,bronchiectasis and so on.Results The average operation time of lobectomy was (170±32) min,the average intraoperative blood loss was (205±145) mL,the average postoperative thoracic drainage time was (3.7±2.1)days,the average postoperative hospital stay was (8.3±3.1) days.Only one case converted to open approach while 8 patients needed to be treated again with pleural effusion.The mean time of partial lung resection surgery was (64±32)min,the mean intraoperative bleeding was (68±23) mL,the mean thoracic drainage time was (3.0±1.9) days,and the mean postoperative hospital stay was(5.7±1.8)days.One case of persistent postoperative leakage recovered after conservative treatment.There were no other complications and death occurred.Followed up for 3-12 months,all patients recovered well and no recurrence of pneumothorax.Conclusion The uniportal video-assisted thoracoscopic surgery in pulmonary resection is safe and feasible.It is a new minimally invasive surgical approach with satisfactory short-term outcome,and it is worth to be applied in pulmonary diseases.