Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China.
J Thorac Dis. 2013 Aug;5 Suppl 3(Suppl 3):S298-300. doi: 10.3978/j.issn.2072-1439.2013.08.29.
This video demonstrates a case undergoing complete video-assisted thoracoscopic surgery (VATS) upper left bronchial sleeve lobectomy. The 18-year-old female patient was admitted for recurrent cough and intermittent hemoptysis for one month. Chest CT scan showed a neoplasm in the left main bronchus and the left upper lobe bronchus. Bronchoscopic biopsy indicated mucinous epithelial cancer. Based on the chest CT findings, the left lower lung was not affected. To preserve normal lung tissue and minimize the loss of lung function, we decided to perform this surgical procedure. A three-port technique was conducted, in which the hypoplastic oblique fissure, the left upper pulmonary vein, and the upper lobe branch of the left pulmonary artery were initially treated under complete VATS. Bronchial sleeve lobectomy of the upper lobe of the left lung was finally carried out. The key to success was the end-to-end anastomosis between the left main bronchus and the lower left bronchus under thoracoscope. The deep location of the operative field partly hidden under the left pulmonary artery trunk during bronchial anastomosis made it even more difficult to operate thoracoscopically. To improve exposure of the operative field, we managed to raise the left main bronchus by passing two 1-0 silk sutures, respectively ligated with both sides of the posterior wall of the left main bronchus, through the anterior and posterior chest walls using a crochet needle. Similarly, a 1-0 silk suture was advanced through the posterior chest wall with a crochet needle to lift the trunk of the left pulmonary artery. In this way, a widely open, exposed field was achieved. Postoperative recovery was smooth. Chest X-ray showed good expansion of the left lung. Bronchoscopy indicated a patent anastomosis. The patient was discharged after two weeks. In conclusion, complete VATS bronchial sleeve lobectomy is a minimally invasive approach for thorough removal of tumor lesions while sparing as most normal lung tissue as possible, which avoids pneumonectomy and satisfies the psychological and physiological needs of patients.
这段视频演示了一例完全胸腔镜辅助下（VATS）左上支气管袖状肺叶切除术。该 18 岁女性患者因反复咳嗽和间歇性咯血 1 个月入院。胸部 CT 扫描显示左主支气管和左上叶支气管有肿瘤。支气管镜活检提示黏液上皮癌。根据胸部 CT 结果，左下肺未受影响。为了保留正常的肺组织并尽量减少肺功能的损失，我们决定进行该手术。采用三孔技术，首先在完全 VATS 下处理发育不良的斜裂、左上肺静脉和左上肺动脉的上叶分支。最后进行左肺上叶支气管袖状肺叶切除术。成功的关键是在胸腔镜下完成左主支气管与左下支气管的端端吻合。支气管吻合时，由于术野深，部分被左肺动脉干遮挡，使胸腔镜操作更加困难。为了改善术野暴露，我们成功地通过两根 1-0 丝线将左主支气管提起，分别结扎左主支气管后壁两侧，然后通过前胸壁和后胸壁用曲柄针穿过。同样，用曲柄针将一根 1-0 丝线从后胸壁穿过，提起左肺动脉干。这样就可以获得一个广泛开放、暴露良好的术野。术后恢复顺利。胸部 X 线显示左肺扩张良好。支气管镜检查显示吻合口通畅。患者两周后出院。总之，完全 VATS 支气管袖状肺叶切除术是一种微创方法，可以彻底切除肿瘤病变，同时尽可能保留更多的正常肺组织，避免全肺切除术，满足患者的心理和生理需求。
