Baysungur Volkan, Dogruyol Talha, Ocakcioglu Ilhan, Misirlioglu Aysun, Evman Serdar, Kanbur Serda, Alpay Levent, Tezel Cagatay
*Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital †Department of Thoracic Surgery, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey.
Surg Laparosc Endosc Percutan Tech. 2017 Jun;27(3):194-196. doi: 10.1097/SLE.0000000000000408.
Minimally invasive surgery is the treatment of choice in early-stage lung cancer. However, experience in infectious lung disease, primarily bronchiectasis, is limited probably because of the presence of dense pleural adhesions, multiple lymph nodes, and spiral bronchial arteries. The present study shows our experience of video-assisted thoracoscopic surgery (VATS) lobectomy and segmentectomy in the treatment of bronchiectasis.
Patients who underwent VATS lobectomy or segmentectomy in our clinic between April 2008 and 2015 were retrospectively evaluated. Surgery was indicated in patients with radiologic localized bronchiectasis who also had a history of recurrent lower respiratory tract infection or expectorating mucopurulent secretion. The patients were analyzed in terms of age, sex, thoracotomy conversion rate, postoperative drainage amount, chest tube removal time, length of hospital stay, morbidity, and mortality.
A total of 44 patients initially underwent VATS pulmonary anatomic resection and 41 procedures were completed on 40 patients. One patient had bilateral resection. Fifteen patients were male individuals and 26 were female individuals. The average age was 31.4 (15 to 57) years. Forty lobectomies and 1 segmentectomy were performed. The conversion rate was 6.8%. VATS was performed on 28 patients by 3 ports, 8 patients by 2 ports, and 5 patients by a single port. In terms of anatomic resections, 18 patients underwent left lower lobectomy, 8 right lower lobectomy, 8 middle lobectomy, 6 right upper lobectomy, and 1 patient underwent lingular segmentectomy. No major postoperative complication or mortality was observed. Prolonged air leak was observed in 2 patients and subcutaneous emphysema occurred in 2 patients. The average postoperative drainage amount, chest tube removal time, and length of hospital stay were 320 mL, 3.1 (1 to 11) days, and 4.6 (2 to 11) days, respectively.
VATS pulmonary resection is a safe, feasible, and effective treatment in the surgery of bronchiectasis with low morbidity and mortality rates. Moreover, because of cosmetic results, patients with benign diseases such as bronchiectasis could be initiated by minimally invasive surgery options just like patients with malignancies.
微创手术是早期肺癌的首选治疗方法。然而，在感染性肺部疾病（主要是支气管扩张症）方面的经验有限，这可能是由于存在致密的胸膜粘连、多个淋巴结和螺旋状支气管动脉。本研究展示了我们在电视辅助胸腔镜手术（VATS）肺叶切除术和肺段切除术治疗支气管扩张症方面的经验。
对2008年4月至2015年期间在我院接受VATS肺叶切除术或肺段切除术的患者进行回顾性评估。手术适用于有放射学定位支气管扩张且有反复下呼吸道感染或咳出黏液脓性分泌物病史的患者。对患者的年龄、性别、开胸手术转换率、术后引流量、胸管拔除时间、住院时间、发病率和死亡率进行分析。
共有44例患者最初接受VATS肺解剖切除术，40例患者完成了41例手术。1例患者接受了双侧切除术。男性患者15例，女性患者26例。平均年龄为31.4（15至57）岁。进行了40例肺叶切除术和1例肺段切除术。转换率为6.8%。28例患者通过3个切口进行VATS手术，8例通过2个切口，5例通过单个切口。在解剖切除方面，18例患者接受左下肺叶切除术，8例接受右下肺叶切除术，8例接受中叶切除术，6例接受右上肺叶切除术，1例接受舌段切除术。未观察到重大术后并发症或死亡。2例患者出现持续性漏气，2例患者发生皮下气肿。术后平均引流量、胸管拔除时间和住院时间分别为320 mL、3.1（1至11）天和4.6（2至11）天。
VATS肺切除术是支气管扩张症手术中一种安全、可行且有效的治疗方法，发病率和死亡率较低。此外，由于美容效果，支气管扩张症等良性疾病患者可以像恶性肿瘤患者一样选择微创手术。
