Galvez Carlos, Lirio Francisco, Sesma Julio, Baschwitz Benno, Bolufer Sergio
Thoracic Surgery Department, Hospital General Universitario Alicante, Alicante, Spain.
J Vis Surg. 2017 Aug 30;3:114. doi: 10.21037/jovs.2017.08.02. eCollection 2017.
Unusual anatomical segmentectomies are technically demanding procedures that require a deep knowledge of intralobar anatomy and surgical skill. In the other hand, these procedures preserve more normal lung parenchyma for lesions located in specific anatomical segments, and are indicated for benign lesions, metastasis and also early stage adenocarcinomas without nodal involvement. A 32-year-old woman was diagnosed of a benign pneumocytoma in the anterior segment of the left-lower lobe (S8, LLL), so we performed a single-incision video-assisted thoracoscopic surgery (SI-VATS) anatomical S8 segmentectomy in 140 minutes under intercostal block. There were no intraoperative neither postoperative complications, the chest tube was removed at 24 hours and the patient discharged at 5 postoperative day with low pain on the visual analogue scale (VAS). Final pathologic exam reported a benign sclerosant pneumocytoma with free margins. The patient has recovered her normal activities at 3 months completely with radiological normal controls at 1 and 3 months.
非常规解剖性肺段切除术是技术要求很高的手术，需要对肺叶内解剖结构有深入了解和具备手术技巧。另一方面，对于位于特定解剖肺段的病变，这些手术能保留更多正常肺实质，适用于良性病变、转移瘤以及无淋巴结转移的早期腺癌。一名32岁女性被诊断为左肺下叶前段（S8，LLL）的良性肺细胞瘤，因此我们在肋间阻滞下，于140分钟内通过单孔电视辅助胸腔镜手术（SI-VATS）行解剖性S8肺段切除术。术中及术后均无并发症，术后24小时拔除胸管，术后第5天患者出院，视觉模拟评分（VAS）疼痛程度低。最终病理检查报告为切缘阴性的良性硬化性肺细胞瘤。患者在3个月时已完全恢复正常活动，术后1个月和3个月影像学检查均正常。
