Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Kunming City, Yunnan Province, China.
Department of Thoracic Surgery, Taihe Hospital (Hubei University of Medicine), Shiyan, China.
J Cardiothorac Surg. 2021 May 21;16(1):138. doi: 10.1186/s13019-021-01519-6.
Systematic lymph node dissection is an important part of radical resection for lung cancer. Insufficient incision of the mediastinal pleura results in a tapered or tunnel-like operation surface, which increases the difficulty of uniportal video-assisted thoracoscopic mediastinal lymph node dissection. The objective of this study was to report our concept of broad exposure and investigate the efficacy and safety of this concept in uniportal video-assisted thoracoscopic mediastinal lymph nodes dissection.
We retrospectively analyzed the clinical data of the 204 non-small cell lung cancer patients who underwent uniportal video-assisted thoracoscopic surgery for anatomical lobectomy and systematic lymph node dissection following the concept of broad exposure. SPSS 23.0 software was used for statistical analysis.
All operations were completed under uniportal video-assisted thoracoscopic surgery following the concept of broad exposure. The median surgery time was 102 (range, 76-285) minutes and the median blood loss was 50 (range, 20-900) milliliters. The median chest tube duration time was 2 (range, 1-6) days, the median postoperative hospital duration time was 5 (range, 4-10) days. The median number of dissected lymph node stations and dissected lymph nodes were 8 (range,6-9) and 15(range,12-19), respectively. The median number of dissected mediastinal lymph nodes stations and dissected mediastinal lymph nodes were 5(range,3-6) and 11(range,10-15), respectively. The up-staging rate of N staging was 6.86%. The postoperative complication rate was 10.29% and there was no perioperative death.
According to our results, it's effective and safe to perform uniportal video-assisted thoracoscopic mediastinal lymph nodes dissection following the concept of broad exposure. This new concept not only emphasizes sufficient exposure, but also focuses on protection of important tissues.
系统性淋巴结清扫是肺癌根治性切除的重要组成部分。纵隔胸膜切开不足导致手术表面呈锥形或隧道状，增加了单孔电视辅助胸腔镜纵隔淋巴结清扫的难度。本研究旨在报告我们的广泛显露概念，并探讨该概念在单孔电视辅助胸腔镜纵隔淋巴结清扫中的疗效和安全性。
我们回顾性分析了 204 例非小细胞肺癌患者的临床资料，这些患者均采用单孔电视辅助胸腔镜解剖性肺叶切除术和系统性淋巴结清扫术，采用广泛显露概念。采用 SPSS 23.0 软件进行统计分析。
所有手术均在单孔电视辅助胸腔镜下完成，采用广泛显露概念。手术时间中位数为 102（76-285）分钟，出血量中位数为 50（20-900）毫升。胸腔引流管留置时间中位数为 2（1-6）天，术后住院时间中位数为 5（4-10）天。淋巴结清扫站和淋巴结的中位数分别为 8（6-9）和 15（12-19）个，纵隔淋巴结清扫站和纵隔淋巴结的中位数分别为 5（3-6）和 11（10-15）个。N 分期的升级率为 6.86%。术后并发症发生率为 10.29%，无围手术期死亡。
根据我们的结果，采用广泛显露概念行单孔电视辅助胸腔镜纵隔淋巴结清扫术是有效和安全的。这一新概念不仅强调充分显露，还注重重要组织的保护。
