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非小细胞肺癌患者单孔电视辅助胸腔镜手术(VATS)袖状切除术:一项观察性前瞻性研究及技术分析

Uniportal video-assisted thoracoscopic surgery (VATS) sleeve resections for non-small cell lung cancer patients: an observational prospective study and technique analysis.

作者信息

Koryllos Aris, Stoelben Erich

机构信息

Department of Thoracic Surgery, Lung Clinic Merheim, State Hospital of Cologne, University of Witten Herdecke, Cologne, Germany.

出版信息

J Vis Surg. 2018 Jan 17;4:16. doi: 10.21037/jovs.2017.12.22. eCollection 2018.

Abstract

Bronchus sleeve resection for operative treatment of non-small cell lung cancer (NSCLC) is a gold standard in modern thoracic surgery in cases of centrally located tumors or hilär lymph node metastases. Advanced instruments and growing surgical experience allowed surgeons to reduce the required incisions (from 3-port to uniportal) and to resect larger and more centrally located malignancies minimal invasively. It is a logical and expected advance in thoracic surgery that video-assisted thoracoscopic surgery (VATS) would be ultimately used also for complex bronchial resections. We therefore present in this study our early clinical results and technique of uniportal sleeve resections for patients with centrally located NSCLC or carcinoids. In the period 2015-2017, n:40 patients with NSCLC were found eligible for uniportal VATS sleeve resection in our institution. In two cases a thoracotomy conversion because of severe hilar scar tissue was necessary. In 38 cases a uniportal VATS sleeve resection could be completed. We believe that uniportal sleeve resections are the logical evolution of VATS allowing patients with locally advanced malignancies to have quicker recovery and reduced perioperative pain.

摘要

支气管袖状切除术用于非小细胞肺癌(NSCLC)的手术治疗,对于中心型肿瘤或肺门淋巴结转移的病例,是现代胸外科的金标准。先进的器械和不断积累的手术经验使外科医生能够减少所需的切口(从三孔到单孔),并以微创方式切除更大且位置更靠近中心的恶性肿瘤。胸腔镜手术(VATS)最终也将用于复杂的支气管切除术,这在胸外科是合乎逻辑且可预期的进展。因此,我们在本研究中展示了我们对中心型NSCLC或类癌患者进行单孔袖状切除术的早期临床结果和技术。在2015年至2017年期间,我们机构中有40例NSCLC患者被认为适合进行单孔VATS袖状切除术。有2例因严重的肺门瘢痕组织而需要转为开胸手术。在38例中,单孔VATS袖状切除术得以完成。我们认为单孔袖状切除术是VATS的合理演进,能使局部晚期恶性肿瘤患者更快康复并减轻围手术期疼痛。

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