Miyazaki Takuro, Nagayasu Takeshi, Yamasaki Naoya, Tsuchiya Tomoshi, Matsumoto Keitaro, Tagawa Tsutomu, Obatake Masayuki, Nanashima Atsushi, Hidaka Shigekazu, Hayashi Tomayoshi
Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Gen Thorac Cardiovasc Surg. 2014 Oct;62(10):614-9. doi: 10.1007/s11748-014-0408-8. Epub 2014 Apr 28.
Recently, the prone position has been used for thoracoscopic oesophagectomy for oesophageal cancer because it is known to facilitate mediastinal dissection. We hypothesized that this advantage of the prone position could apply to video-assisted thoracoscopic surgery, which has been commonly performed with the patient in the lateral position.
Forty-six patients with clinical stage I, right-sided, non-small cell lung cancer were enrolled in this study. They were classified into three groups: conventional thoracotomy using rib retractors (n = 17), and the lateral (n = 15) and semi-prone (n = 14) positions in video-assisted thoracoscopic surgery. Surgical parameters, such as operation time, the amount of blood loss, and the number of dissected lymph nodes, of each group of patients were compared.
There were three (6.5 %) minor complications in this study, chylothorax and heart failure in the thoracotomy group and atelectasis with the video-assisted thoracoscopic surgery in the lateral position group. No complications were seen in the semi-prone group. The number of dissected lymph nodes was significantly higher in the video-assisted thoracoscopic surgery in the semi-prone position group than in the conventional thoracotomy group for inferior mediastinal nodes (subcarinal, paraeosophageal, and pulmonary ligament, average 8.9 and 5.9 lymph nodes, p = 0.04).
To the best of our knowledge, this is the first report that has described video-assisted thoracoscopic lobectomy with the patient in the semi-prone position. Although the number of cases was limited, the results of this study show that the semi-prone position could be attempted especially for right lower lobe lung cancer.
最近，俯卧位已被用于食管癌的胸腔镜食管切除术，因为已知它有助于纵隔解剖。我们假设俯卧位的这一优势也适用于电视辅助胸腔镜手术，而该手术通常是在患者侧卧位下进行的。
46例临床I期、右侧、非小细胞肺癌患者纳入本研究。他们被分为三组：使用肋骨牵开器的传统开胸手术组（n = 17），电视辅助胸腔镜手术的侧卧位组（n = 15）和半俯卧位组（n = 14）。比较每组患者的手术参数，如手术时间、失血量和清扫淋巴结数量。
本研究中有3例（6.5%）轻微并发症，开胸手术组出现乳糜胸和心力衰竭，侧卧位电视辅助胸腔镜手术组出现肺不张。半俯卧位组未出现并发症。半俯卧位电视辅助胸腔镜手术组清扫的下纵隔淋巴结数量显著高于传统开胸手术组（隆突下、食管旁和肺韧带，平均8.9个和5.9个淋巴结，p = 0.04）。
据我们所知，这是第一份描述患者处于半俯卧位的电视辅助胸腔镜肺叶切除术的报告。尽管病例数量有限，但本研究结果表明，尤其是对于右下叶肺癌，可以尝试半俯卧位。
