Xie Dong, Wang Haifeng, Fei Ke, Chen Chang, Zhao Deping, Zhou Xiao, Xie Boxiong, Jiang Lei, Chen Qiankun, Song Nan, Dai Jie, Jiang Gening, Zhu Yuming
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
Eur J Cardiothorac Surg. 2016 Jan;49 Suppl 1:i31-6. doi: 10.1093/ejcts/ezv408.
Single-port video-assisted thoracic surgery (VATS) technique has been used for thoracic diseases. There was no report about single-port VATS in large series. Outcomes following single-port VATS were analysed to determine its efficacy and safety.
From June 2012 to June 2014, 1063 single-port VATSs were performed by four surgeons. Patient demographics, perioperative parameters, histopathology and outcomes were analysed.
There were 1063 patients (524 men and 539 women). The median age was 56.1 ± 8.7 years (range, 15-86 years). Lobectomy was performed in 569 patients, segmentectomy in 162, wedge resection in 264, pleural biopsy in 7, drainage of effusion in 20, pleural tumour resection in 5, mediastinal tumour resection in 54, mediastinal tumour biopsy in 2, bilobectomy in 7, sleeve lobectomy in 3 and pneumonectomy in 2. Synchronous bilateral single-port VATS was performed in 27 cases, whereas metachronous bilateral single-port VATS was performed in 5 cases. Pathological diagnoses included primary lung cancer in 635 cases, metastatic lung cancer in 19, mediastinal tumour in 56, pleural disease in 32 and benign pulmonary conditions in 353. Fifteen intraoperative vascular injuries were identified in 15 patients. The total conversion rate was 4.6%. The average operation time was 135 ± 31 min (range, 30-230 min), and the average blood loss was 117 ± 47 ml (range, 50-2000 ml). The median intensive care unit stay was 1 day (0-4 days). The postoperative hospital stay was 6.2 ± 2.6 days on average. There was no operative death, and operative complications occurred in 59 patients (5.6%). The 1-year overall survival and 1-year disease-free survival for the primary lung cancer group were 98 and 96%, respectively.
Our findings indicate that single-port VATS for thoracic diseases is safe and feasible.
单孔电视辅助胸腔镜手术（VATS）技术已用于治疗胸部疾病。目前尚无关于大宗病例单孔VATS的报道。分析单孔VATS后的结果以确定其有效性和安全性。
2012年6月至2014年6月，4名外科医生实施了1063例单孔VATS手术。分析患者的人口统计学资料、围手术期参数、组织病理学及结果。
共有1063例患者（男性524例，女性539例）。中位年龄为56.1±8.7岁（范围15 - 86岁）。569例行肺叶切除术，162例行肺段切除术，264例行楔形切除术，7例行胸膜活检，20例行胸腔积液引流，5例行胸膜肿瘤切除术，54例行纵隔肿瘤切除术，2例行纵隔肿瘤活检，7例行双叶切除术，3例行袖式肺叶切除术，2例行全肺切除术。同期双侧单孔VATS手术27例，而异期双侧单孔VATS手术5例。病理诊断包括原发性肺癌635例，转移性肺癌19例，纵隔肿瘤56例，胸膜疾病32例，良性肺部疾病353例。15例患者术中发现血管损伤。总中转率为4.6%。平均手术时间为135±31分钟（范围30 - 230分钟），平均失血量为117±47毫升（范围50 - 2000毫升）。中位重症监护病房停留时间为1天（0 - 4天）。术后平均住院时间为6.2±2.6天。无手术死亡，59例患者（5.6%）发生手术并发症。原发性肺癌组1年总生存率和1年无病生存率分别为98%和96%。
我们的研究结果表明，单孔VATS治疗胸部疾病是安全可行的。
