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胸腔镜下对主要肺切除进行同侧再次手术的可行性研究

Feasibility Investigation of Ipsilateral Reoperations by Thoracoscopy for Major Lung Resection.

作者信息

Sun Weiyan, Zhang Lei, Li Zeyao, Chen Donglai, Jiang Gening, Hu Jian, Chen Chang

机构信息

Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.

Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China.

出版信息

Thorac Cardiovasc Surg. 2020 Apr;68(3):241-245. doi: 10.1055/s-0039-1683372. Epub 2019 Mar 28.

Abstract

BACKGROUND

Video-assisted thoracoscopic surgery (VATS) has become the preferred approach for minimizing harm from thoracic operations. There is no report, however, which has discussed the feasibility of VATS in ipsilateral reoperation of major lung resection.

METHODS

The present study included patients who had undergone ipsilateral reoperation of major lung resection by VATS from October 2009 to May 2017. Referring clinical data were recruited for analysis.

RESULTS

Fourteen patients were recruited in the present study, including nine patients who underwent lobectomy and five who underwent segmentectomy during the second operation. Different hila were found in 6 patients, and pleural adhesions appeared in 10 patients. The average intraoperative blood loss was 203.6 ± 121.7 mL, and the mean operating room time was 2.2 ± 0.5 hours. There were no intraoperative deaths, and only one patient required conversion to thoracotomy. The average drainage time was 5.9 ± 4.6, and the mean hospital stay was 6.7 ± 4.2 days.

CONCLUSION

Though it is technically demanding to safely handle the changed hilum structure caused by the last operation, major lung resection by VATS is feasible for ipsilateral reoperation in appropriate candidates.

摘要

背景

电视辅助胸腔镜手术(VATS)已成为将胸科手术伤害降至最低的首选方法。然而,尚无报告讨论VATS在同侧再次进行肺大部切除术的可行性。

方法

本研究纳入了2009年10月至2017年5月期间接受VATS同侧再次肺大部切除术的患者。收集相关临床资料进行分析。

结果

本研究共纳入14例患者,其中9例在第二次手术中接受了肺叶切除术,5例接受了肺段切除术。6例患者发现不同的肺门情况,10例患者出现胸膜粘连。术中平均失血量为203.6±121.7 mL,平均手术时间为2.2±0.5小时。无术中死亡病例,仅1例患者需要转为开胸手术。平均引流时间为5.9±4.6天,平均住院时间为6.7±4.2天。

结论

尽管安全处理上次手术导致的肺门结构改变在技术上具有挑战性,但对于合适的患者,VATS进行同侧再次肺大部切除术是可行的。

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