Xu Xin, Chen Hanzhang, Yin Weiqiang, Shao Wenlong, Wang Wei, Peng Guilin, Huang Jun, He Jianxing
Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China.
Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China
Eur J Cardiothorac Surg. 2015 Jan;47(1):e8-12. doi: 10.1093/ejcts/ezu416. Epub 2014 Nov 16.
The objectives of this study were to report the surgical techniques and clinical outcome of thoracoscopic lobectomy with partial removal of the superior vena cava for lung carcinomas.
Between January 2010 and November 2013, 1132 patients with lung cancer underwent radical surgery by thoracoscopy; 5 (0.4%) underwent thoracoscopic lobectomy with partial removal of the superior vena cava. Perioperative variables and postoperative outcomes of these cases were analysed to evaluate the technical feasibility and safety of this operation.
For all cases, a right upper lobectomy was performed. The average time of surgery was 260 min (range, 170-380, 260±90 min).The intraoperative blood loss averaged 160 ml (range, 50-300, 160±90 ml). The median postoperative hospital stay was 11 days (interquartile range, 7-15 days). Postoperatively, tracheal extubation was achieved in the recovery room without further need for mechanical ventilation. In 1 case, the patient experienced postoperative superior vena cava thrombosis; he recovered after administration of anticoagulation drugs. None of the patients developed active blood leakage postoperatively. Perioperative mortality was not observed.
Thoracoscopic lobectomy with partial removal of the superior vena cava can be considered a feasible and safe operation for selected patients with lung cancer.
本研究的目的是报告胸腔镜肺叶切除术联合部分上腔静脉切除术治疗肺癌的手术技术及临床结果。
2010年1月至2013年11月期间，1132例肺癌患者接受了胸腔镜根治性手术；其中5例（0.4%）接受了胸腔镜肺叶切除术联合部分上腔静脉切除术。分析这些病例的围手术期变量和术后结果，以评估该手术的技术可行性和安全性。
所有病例均行右上肺叶切除术。平均手术时间为260分钟（范围170 - 380分钟，260±90分钟）。术中平均出血量为160毫升（范围50 - 300毫升，160±90毫升）。术后中位住院时间为11天（四分位间距7 - 15天）。术后，患者在恢复室实现气管拔管，无需进一步机械通气。1例患者术后发生上腔静脉血栓形成；给予抗凝药物治疗后康复。所有患者术后均未发生活动性出血。未观察到围手术期死亡。
对于部分选定的肺癌患者，胸腔镜肺叶切除术联合部分上腔静脉切除术可被认为是一种可行且安全的手术。
