Yang Shun-Mao, Wang Man-Ling, Hung Ming-Hui, Hsu Hsao-Hsun, Cheng Ya-Jung, Chen Jin-Shing
Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan; Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
Ann Thorac Surg. 2017 Feb;103(2):462-468. doi: 10.1016/j.athoracsur.2016.09.006. Epub 2016 Nov 16.
Endotracheal intubation and chest tube drainage are considered mandatory for thoracoscopic pulmonary resection. The management of peripheral lung nodules by tubeless uniportal thoracoscopic surgical repair has not been reported previously.
From October 2015 through January 2016, 30 consecutive patients with peripheral lung nodules underwent uniportal thoracoscopic wedge resection without endotracheal intubation and chest tube drainage (tubeless group). The clinical outcomes were compared with the outcomes in 30 consecutive patients with peripheral lung nodules who underwent uniportal thoracoscopic wedge resection with chest tube drainage from April through October 2015 (chest tube group).
The demographic, anesthetic, and operative characteristics of the patients were comparable in both groups. No major adverse events occurred after operation. A small residual pneumothorax was noted in 12 (40.0%) patients at 6 hours and day 1 and in 2 (6.6%) patients on day 14 in the tubeless group. No patient required reintervention or readmission to the hospital. Patients in the tubeless group had lower pain scale scores on postoperative day 1 (mean, 1.0 vs 1.5, p = 0.012) and shorter postoperative hospital stays (mean, 3.1 days vs 4.4 days, p = 0.011) than did those in the chest tube group.
Tubeless uniportal thoracoscopic wedge resection is feasible and safe and may be a less invasive alternative for treating selected patients with peripheral lung nodules.
胸腔镜肺切除术时气管插管和胸腔闭式引流被认为是必需的。此前尚无关于无管单孔胸腔镜手术治疗周围型肺结节的报道。
2015年10月至2016年1月，连续30例周围型肺结节患者接受了无气管插管和胸腔闭式引流的单孔胸腔镜楔形切除术（无管组）。将临床结果与2015年4月至10月连续30例接受单孔胸腔镜楔形切除术并胸腔闭式引流的周围型肺结节患者的结果进行比较（胸腔闭式引流组）。
两组患者的人口统计学、麻醉和手术特征具有可比性。术后未发生重大不良事件。无管组中，12例（40.0%）患者在术后6小时和第1天出现少量残余气胸，2例（6.6%）患者在第14天出现少量残余气胸。无一例患者需要再次干预或再次入院。与胸腔闭式引流组相比，无管组患者术后第1天的疼痛评分较低（平均1.0分对1.5分，p = 0.012），术后住院时间较短（平均3.1天对4.4天，p = 0.011）。
无管单孔胸腔镜楔形切除术可行且安全，对于部分周围型肺结节患者可能是一种侵入性较小的替代治疗方法。
