Hung Wan-Ting, Hsu Hsao-Hsun, Hung Ming-Hui, Hsieh Pei-Yin, Cheng Ya-Jung, Chen Jin-Shing
1 Division of Thoracic Surgery, Department of Surgery, 2 Department of Anesthesiology, 3 Department of Nursing, 4 Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
J Thorac Dis. 2016 Mar;8(Suppl 3):S242-50. doi: 10.3978/j.issn.2072-1439.2016.02.09.
Sporadic case reports have shown that wedge resection and lobectomy can be performed via nonintubated video-assisted thoracoscopic surgery (VATS) with a single incision. We report the feasibility and safety of nonintubated uniportal VATS for resection of various lung lesions.
From January 2014 to June 2015, we retrospectively reviewed the records of 116 consecutive patients who underwent nonintubated uniportal VATS for diagnosis or treatment of lung lesions. We used a combination of intrathoracic intercostal nerve block, vagal block, and target-controlled sedation to maintain adequate anesthesia without tracheal intubation. Computed tomography (CT)-guided dye localization and anchoring sutures were applied to facilitate single-incision VATS.
Of the 116 patients, 76 (66%) presented with ground-glass nodules on preoperative CT imaging. Overall, 125 nodules were identified on CT in the 116 patients. Most lesions were less than 10 mm in size (77/125, 62%). About two-thirds of patients underwent CT-guided dye localization of the lesions before uniportal VATS. A wedge resection with or without lymphadenectomy was performed in 107 (92%) patients, segmentectomy with lymphadenectomy, in 7 (6%), and lobectomy with lymphadenectomy, in 2 (2%) patients. Five of the 116 (4.3%) patients underwent conversion to multiport VATS, and one (0.9%) patient underwent conversion to endotracheal-intubated multiport VATS. Four (3.4%) patients had operative complications including air leakage for more than 3 days, bleeding, and pneumonia. Postoperative pain was mild. The median postoperative hospital stay was 3 days. The major pathological diagnoses of the 129 resected lesions were primary lung adenocarcinoma in 82 (64%), with predominantly stage IA disease (79/82, 96%), followed by benign tumors (18/129, 14%), metastatic tumors (17/129, 13%), pre-invasive lesions of lung (8/129, 6%), lymphoma (2/129, 1.6%), and interstitial lung disease (2/129, 1.6%).
Nonintubated uniportal VATS is technically feasible, effective, and safe for diagnosis and treatment of various lung lesions in selected patients.
散在的病例报告显示，楔形切除术和肺叶切除术可通过单切口非插管电视辅助胸腔镜手术（VATS）完成。我们报告非插管单孔VATS切除各种肺部病变的可行性和安全性。
2014年1月至2015年6月，我们回顾性分析了116例连续接受非插管单孔VATS诊断或治疗肺部病变患者的记录。我们采用胸腔内肋间神经阻滞、迷走神经阻滞和靶控镇静相结合的方法，在不进行气管插管的情况下维持充分的麻醉。应用计算机断层扫描（CT）引导下染料定位和锚定缝线以促进单切口VATS。
116例患者中，76例（66%）术前CT影像表现为磨玻璃结节。总体而言，116例患者的CT共发现125个结节。大多数病变大小小于10 mm（77/125，62%）。约三分之二的患者在单孔VATS前接受了CT引导下病变染料定位。107例（92%）患者行楔形切除术，伴或不伴淋巴结清扫；7例（6%）患者行肺段切除术加淋巴结清扫；2例（2%）患者行肺叶切除术加淋巴结清扫。116例患者中有5例（4.3%）转为多孔VATS，1例（0.9%）患者转为气管插管多孔VATS。4例（3.4%）患者出现手术并发症，包括漏气超过3天、出血和肺炎。术后疼痛轻微。术后中位住院时间为3天。129个切除病变的主要病理诊断为原发性肺腺癌82例（64%），主要为IA期疾病（79/82，96%），其次为良性肿瘤（18/129，14%）、转移性肿瘤（17/129，13%）、肺浸润前病变（8/129，6%）、淋巴瘤（2/129，1.6%）和间质性肺疾病（2/129，1.6%）。
非插管单孔VATS对特定患者诊断和治疗各种肺部病变在技术上是可行、有效且安全的。
