Li Zeyao, Li Yingze, Wang Long, Duan Liang, Gonzalez-Rivas Diego, Jiang Gening, Chen Chang
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.
Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain.
J Thorac Dis. 2019 Mar;11(3):657-663. doi: 10.21037/jtd.2019.02.71.
Our objective in this paper is to introduce a new method for handling calcified hilar lymph nodes during lobectomies by video-assisted thoracoscopy that effectively avoids arterial injury and possible conversions.
The 12 cases in this study were initially evaluated as eligible and were subsequently scheduled for thoracoscopic lobectomies. However, calcification of the hilar lymph nodes was discovered during the operations, and its presence hampered the conventional process of pulmonary artery dissection. To avoid vessel injuries and subsequent massive bleeding, we developed two techniques specific to the position and exposure of the target vessels and nodes. The space between the bronchus and lymph nodes is exposed by sharp dissection ("scissor first") either before or after suturing the artery. These techniques are illustrated in detail.
Seven male and five female patients participated in this study, with an average age of 72.5 years. We performed five right-upper lobectomies, three right-middle lobectomies, three right-lower lobectomies, and a left-lower lobectomy. Using this new technique, no conversions to thoracotomy occurred. The average operation time was 125 minutes, the mean blood loss was 275 mL, and no intra-operative massive bleeding occurred. Two patients experienced minor complications, one pulmonary infection and another postoperative subcutaneous emphysema.
The proposed "scissor first" technique provides an effective solution for the thoracoscopic management of calcified hilar lymph nodes, and is a safe and effective method for avoiding arterial injury and conversion.
本文的目的是介绍一种在电视辅助胸腔镜肺叶切除术中处理钙化肺门淋巴结的新方法，该方法能有效避免动脉损伤及可能的中转开胸。
本研究中的12例患者最初被评估为符合条件，随后安排进行胸腔镜肺叶切除术。然而，手术过程中发现肺门淋巴结钙化，其存在阻碍了肺动脉常规的解剖过程。为避免血管损伤及随后的大出血，我们针对目标血管和淋巴结的位置及暴露情况开发了两种技术。在缝合动脉之前或之后，通过锐性分离（“先剪刀法”）暴露支气管与淋巴结之间的间隙。详细阐述了这些技术。
7名男性和5名女性患者参与了本研究，平均年龄为72.5岁。我们进行了5例右上叶切除术、3例右中叶切除术、3例右下叶切除术和1例左下叶切除术。使用这种新技术，未发生中转开胸。平均手术时间为125分钟，平均失血量为275毫升，术中未发生大出血。2例患者出现轻微并发症，1例肺部感染，另1例术后皮下气肿。
所提出的“先剪刀法”技术为胸腔镜下处理钙化肺门淋巴结提供了一种有效的解决方案，是避免动脉损伤和中转开胸的安全有效方法。
