Aragaki Masato, Kaga Kichizo, Hida Yasuhiro, Kato Tatsuya, Matsui Yoshiro
Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, West-7, North-15, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
Ann Med Surg (Lond). 2019 Jul 26;45:70-74. doi: 10.1016/j.amsu.2019.07.027. eCollection 2019 Sep.
This study aimed to determine the usefulness and limitations of videoassisted thoracoscopic (VATS) lobectomy using one-window and puncture method (1WPM).
This study involved 14 patients who underwent lobectomy using the 1WPM at our institute from 2008 to 2017.
The study patients comprised of 3 men and 11 women with a median age of 10.5 years (range, 0-72 years). There were eight cases in children younger than 18 years old and the youngest patient was 9 days old. The diagnoses were congenital pulmonary cystic disease (n = 7), primary lung cancer (n = 4), metastatic lung tumor (n = 1), and others (n = 2). The 1WPM was successful in 9 of 14 patients (64.3%) and, in 5 cases (35.7%), needed conversion to either two-window method (TWM) using additional port (n = 3) or open thoracotomy (n = 2). The causes for conversion were need for additional bronchoplasty or lymph node dissection (n = 3), failure of one-lung ventilation (n = 1), and presence of a small thoracic cavity that made the procedure extremely difficult (n = 1). In the group that was successfully treated with 1WPM, the median values were as follows: operation time, 193 min (range, 112-480 min); blood loss, 0 ml (range, 0-90 ml); drainage duration, 1 day (range, 1-4 days); and postoperative hospital stay, 7 days (range, 4-13 days).
Lobectomy by 1WPM can be safely performed and has good postoperative course and this procedure can be applicable and effective in small infants.
本研究旨在确定采用单窗口穿刺法（1WPM）的电视辅助胸腔镜（VATS）肺叶切除术的有效性和局限性。
本研究纳入了2008年至2017年在我院采用1WPM进行肺叶切除术的14例患者。
研究患者包括3名男性和11名女性，中位年龄为10.5岁（范围0至72岁）。18岁以下儿童有8例，最年幼的患者为9天。诊断包括先天性肺囊性疾病（n = 7）、原发性肺癌（n = 4）、转移性肺肿瘤（n = 1）及其他（n = 2）。14例患者中有9例（64.3%）1WPM手术成功，5例（35.7%）需要转换为使用额外切口的双窗口法（TWM）（n = 3）或开胸手术（n = 2）。转换原因包括需要额外的支气管成形术或淋巴结清扫（n = 3）、单肺通气失败（n = 1）以及胸腔过小使手术极为困难（n = 1）。在成功采用1WPM治疗的组中，中位值如下：手术时间193分钟（范围112至480分钟）；失血量0毫升（范围0至90毫升）；引流持续时间1天（范围1至4天）；术后住院时间7天（范围4至13天）。
1WPM肺叶切除术可安全进行，术后病程良好，该手术在小婴儿中适用且有效。
