Cheng Kun, Zheng Bin, Zhang Shuliang, Zheng Wei, Guo Zhaohui, Zhu Yong, Chen Chun
Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China.
J Thorac Dis. 2016 Mar;8(Suppl 3):S229-34. doi: 10.3978/j.issn.2072-1439.2016.02.14.
Video-assisted thoracoscopic (VATS) segmentectomy is an acceptable alternative to lobectomy for treating early-stage lung cancer. Uniportal VATS segmentectomy is a challenging surgical procedure that has substantial technical difficulties and complications. In this study, we reviewed our experience of uniportal thoracoscopic segmentectomy and evaluated the feasibility and learning curve of this procedure.
Retrospective observational data of 70 patients who underwent uniportal VATS segmentectomy between May 2014 and July 2015 were collected. Perioperative factors, such as demographic characteristics, operation time, blood loss, the number of dissected mediastinal lymph nodes and nodal stations, conversion rate to three-port VATS or thoracotomy, postoperative complications, duration of chest drainage, and postoperative hospital stay, were reviewed. Cumulative summative analysis and one-way ANOVA were used to identify the learning curve of uniportal thoracoscopic segmentectomy.
Forty cases were included in the study. The patients were equally divided into four groups according to the sequence of surgery. Twelve patients were men and the mean age was 53.7±8.3 years. The mean operation time was 174.2±51.5 minutes and mean blood loss was 81.9±57.4 mL. There were no differences in demographic characteristics, blood loss, number of removed lymph nodes, chest tube duration, and hospital stay among the groups. However, the operation time in group 4 was significantly shorter than that in groups 1-3 (P=0.012). The learning curve showed that after 33 patients, the operation time was less than the conventional average operation time. There was no conversion to three-port VATS, two-port VATS or open thoracotomy. Three patients had postoperative complications and all of them recovered after treatment. No patient needed reoperation. There was no postoperative 30-day-related death.
Uniportal thoracoscopic segmentectomy is a safe and feasible technique for treating small pulmonary lesions, with acceptable morbidity and mortality. This technique can be applied to an operation for segments that are technically difficult and anatomically variant. An experienced surgeon can achieve a relatively stable level after 33 cases.
电视辅助胸腔镜（VATS）肺段切除术是治疗早期肺癌的一种可接受的肺叶切除术替代方法。单孔VATS肺段切除术是一项具有挑战性的手术操作，存在重大技术困难和并发症。在本研究中，我们回顾了我们的单孔胸腔镜肺段切除术经验，并评估了该手术的可行性和学习曲线。
收集2014年5月至2015年7月期间接受单孔VATS肺段切除术的70例患者的回顾性观察数据。回顾围手术期因素，如人口统计学特征、手术时间、失血量、纵隔淋巴结清扫数量和淋巴结站数、转为三孔VATS或开胸手术的转化率、术后并发症、胸腔引流持续时间和术后住院时间。采用累积总和分析和单因素方差分析来确定单孔胸腔镜肺段切除术的学习曲线。
40例患者纳入研究。根据手术顺序将患者平均分为四组。男性12例，平均年龄53.7±8.3岁。平均手术时间为174.2±51.5分钟，平均失血量为81.9±57.4 mL。各组在人口统计学特征、失血量、切除淋巴结数量、胸管留置时间和住院时间方面无差异。然而，第4组的手术时间明显短于第1 - 3组（P = 0.012）。学习曲线显示，在33例患者之后，手术时间少于传统平均手术时间。无转为三孔VATS、两孔VATS或开胸手术的情况。3例患者有术后并发症，经治疗后均康复。无患者需要再次手术。无术后30天相关死亡。
单孔胸腔镜肺段切除术是治疗小的肺部病变的一种安全可行的技术，发病率和死亡率可接受。该技术可应用于技术上困难和解剖结构变异的肺段手术。经验丰富的外科医生在33例手术后可达到相对稳定的水平。
