摘要
目的探讨三维重建指导下胸腔镜精准肺段切除在肺结节手术中的运用及其临床价值。方法回顾性分析2018年12月至2019年12月期间完成的22例胸腔镜精准肺段切除术的临床资料。男10例,女12例;年龄37-72岁,平均(46.2±3.5)岁。术前常规进行胸部薄层CT扫描并对其重要结构和结节进行三维重建,从而了解血管及气管的解剖情况及其有无变异,对病灶位置进行精准解剖定位,制定精准的手术计划。手术一般采用三孔法,根据靶段的不同采用不同的手术流程,采用膨胀萎陷法结合段间静脉确定段间平面,使用电刀超声刀分离和腔镜切割缝合器相结合的方法离断段间肺实质。结果单纯肺段切除20例,联合肺段切除2例。术后病理结果显示良性病变3例,原发性肺癌19例。手术耗时70~120 min,平均90±8 min;出血量30~300 ml,平均150±5.5 ml;术后住院7~12天,平均9.2±1.3天。无围手术期死亡患者,术后并发症2例(9.1%),其中术后咯血1例,肺漏气时间过长1例,所有并发症均治愈。结论胸腔镜下精准肺段切除术是肺结节治疗的一种安全有效的治疗手段。
Objective To explore the application and clinical value of thoracoscopic precise segmental resection under the guidance of three-dimensional reconstruction in pulmonary nodule surgery. Methods The clinical data of 22 cases of thoracoscopic precise segmental pneumonectomy from December 2018 to December 2019 were analyzed retrospectively. There were 10 males and 12 females, with an average age of(46.2 ± 3.5) years. Before operation, conventional thin-layer CT scan of the chest and 3 D reconstruction of its important structures and nodules were carried out, so as to understand the anatomy of blood vessels and trachea and whether there was variation, carry out accurate anatomical location of the focus location, and formulate accurate operation plan.Generally, three hole method was used in the operation. According to the different target segments, different operation procedures were used. Expansion and collapse method was used to determine the inter segment plane in combination with the inter segment vein. The combination of electric knife ultrasonic knife separation and endoscopic incision and suture device was used to disconnect the inter segment lung parenchyma. Results There were 20 cases of simple segmental resection and 2 cases of combined segmental resection. The postoperative pathological results showed benign lesions in 3 cases and primary lung cancer in 19 cases. The average time of operation was 90±8 min(70~120 min);the average bleeding volume was 30~300 ml(150±5.5 ml);the average hospital stay was 9.2±1.3 days(7~12 days). There were no perioperative deaths. Postoperative complications were 2 cases(9.1%), including 1 case of hemoptysis and 1 case of long time of pulmonary leakage. All complications were cured. Conclusion Thoracoscopic accurate segmental pneumonectomy is a safe and effective treatment for pulmonary nodules.
作者
申江峰
贾卫光
卢开进
王嵩
谢于峰
SHEN Jiang-feng;JIA Wei-guang;LU Kai-jin;WANG Song;XIE Yu-feng(Taizhou People's Hospital,Taizhou Jiangsu 225300,China)
出处
《泰州职业技术学院学报》
2020年第5期43-46,共4页
Journal of Taizhou Polytechnic College
关键词
胸腔镜
解剖性肺段切除
三维重建
肺癌
thoracoscopy
anatomical segmental resection
three-dimensional reconstruction
lung cancer
作者简介
申江峰(1979-),男,江苏姜堰人,副主任医师.
