Qu Ji-Chen, Soultanis Konstantinos Marios, Jiang Lei
Department of Thoracic Surgery, Shang Hai Pulmonary Hospital, Shanghai, China.
Department of Thoracic Surgery, 251 Hellenic Airforce General Hospital, Athens, Greece.
J Thorac Dis. 2021 Apr;13(4):2255-2263. doi: 10.21037/jtd-20-3002.
Our study aims to explore the feasibility of uniportal video-assisted complex sleeve lung resection and summarize the surgical techniques and clinical outcomes.
From June 2016 to April 2020, a total of 20 complex sleeve pulmonary and distal tracheal resections were performed by the single surgical team at the Thoracic Surgery Department of the Shanghai Pulmonary Hospital. We defined cases as complex sleeve pulmonary resections if they required pulmonary segment sleeve resection, extended sleeve resection (lobectomy plus segmentectomy of the remaining lobe), sleeve pneumonectomy, lobectomy plus carinoplasty or neo-carina construction, pulmonary-sparing main bronchus resection plus carina reconstruction, and distal trachea resection with end to end anastomosis.
The 20 cases comprised lung squamous cell carcinoma (n=11), lung adenocarcinoma (n=2), hamartoma (n=3), adenoid cystic carcinoma (n=2), carcinoid tumor (n=1), and pleomorphic carcinoma (n=1). The average blood loss during the operation was 250±126.17 mL (50-800 mL). The average operation time was 192.0±61.1 minutes. The average number of lymph node stations removed was 5.82±1.33, including station seven in all cases, and the median number of lymph nodes removed was 4.18±5.89. On the day of surgery, the drainage volume was 266±192.01 mL. The mean postoperative hospital stay was 5.37±1.86 days. Twelve of the 16 patients diagnosed with malignancy received postoperative chemotherapy. Granuloma formation at the anastomosis level led to stenosis in one case, and tumor recurrence occurred in one case. Broncho-esophageal fistula occurred in one patient after radiochemotherapy. The postoperative follow-up time was 15.6±10.7 months. The 30-day mortality was zero, and at one-year follow-up, only one patient had died of metastatic disease after the operation.
Uniportal video-assisted complex sleeve pulmonary resections are feasible when conducted by experienced teams.
本研究旨在探讨单孔电视辅助复杂袖式肺切除术的可行性，并总结手术技术及临床结果。
2016年6月至2020年4月，上海肺科医院胸外科单一手术团队共实施了20例复杂袖式肺及远端气管切除术。若病例需要肺段袖式切除术、扩大袖式切除术（肺叶切除加余肺段切除术）、袖式全肺切除术、肺叶切除加隆突成形术或新隆突构建、保留肺组织的主支气管切除加隆突重建以及远端气管切除端端吻合术，则将其定义为复杂袖式肺切除术。
20例患者包括肺鳞状细胞癌（11例）、肺腺癌（2例）、错构瘤（3例）、腺样囊性癌（2例）、类癌肿瘤（1例）和多形性癌（1例）。手术期间平均失血量为250±126.17毫升（50 - 800毫升）。平均手术时间为192.0±61.1分钟。平均清扫淋巴结站数为5.82±1.33个，所有病例均包括第7组淋巴结，清扫淋巴结中位数为4.18±5.89个。手术当天引流量为266±192.01毫升。术后平均住院时间为5.37±1.86天。16例确诊为恶性肿瘤的患者中有12例接受了术后化疗。吻合口处肉芽肿形成导致1例狭窄，1例出现肿瘤复发。1例患者放化疗后发生支气管食管瘘。术后随访时间为15.6±10.7个月。30天死亡率为零，在1年随访时，仅1例患者术后死于转移性疾病。
由经验丰富的团队进行单孔电视辅助复杂袖式肺切除术是可行的。
