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两厘米单孔切口在减少肋间神经损伤中的应用——用于肺磨玻璃结节的电视辅助胸腔镜手术肺段切除术

Two-Centimeter Single-Port Incision Minimizing Intercostal Nerve Damage Applied in Video-Assisted Thoracoscopic Surgery Segmentectomy for Pulmonary Ground Glass Nodules.

作者信息

Hu Haifeng, Liu Yanzhuo, Dong Ping, Zhang Shaowen, Liu Gaoli, Mao Zhangfan

机构信息

Department of Thoracic Surgery and Renmin Hospital of Wuhan University, Wuhan, People's Republic of China.

Department of Pharmacology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China.

出版信息

J Laparoendosc Adv Surg Tech A. 2023 Jul;33(7):648-653. doi: 10.1089/lap.2022.0541. Epub 2023 Apr 4.

Abstract

We introduced a novel modified 2-cm single-port incision made by blunt separation minimizing intercostal muscle and nerve damage applied in video-assisted thoracoscopic surgery (VATS) segmentectomy, and compared it with the traditional single-port incision or the novel incision plus a 3-mm tiny port, aiming to explore a more minimally invasive single-port technique for VATS segmentectomy. We retrospectively analyzed the clinical data of 174 pulmonary ground glass nodule patients who received single-port VATS segmentectomy (54 modified 2-cm single port, 67 modified single port plus tiny port, and 53 traditional single port, respectively) in our medical center from May 2020 to December 2022. Three kinds of approaches were compared retrospectively, concerning their safety, feasibility, and postoperative pain. There were no serious complications and mortality in either group. The blood loss, tube duration, and hospitalization time were comparable among the three groups ( > .05). The 2-cm single-port and 2-cm single-port plus tiny-port group were obviously more advantageous in the visual analog scores of postoperative pain, the wound numbness, incision healing and appearance than that in the traditional group ( < .05), while they were comparable. Notably, the operation time of the 2-cm plus tiny-port group was shorter than that of the 2-cm group ( < .05) and similar to the traditional single-port group. The 2-cm modified single-port applied for VATS segmentectomy is feasible and safe, and has obviously advantages in postoperative pain, numbness, and appearance of incision. With addition of tiny port, the convenience of the operation can be significantly increased without increasing pain. Our finding could provide a promising new incision mode for VATS segmentectomy.

摘要

我们引入了一种新型改良的2厘米单孔切口,通过钝性分离制作,最大限度减少肋间肌肉和神经损伤,应用于电视辅助胸腔镜手术(VATS)肺段切除术,并将其与传统单孔切口或新型切口加一个3毫米微小切口进行比较,旨在探索一种用于VATS肺段切除术的更微创单孔技术。我们回顾性分析了2020年5月至2022年12月在我们医疗中心接受单孔VATS肺段切除术的174例肺磨玻璃结节患者的临床资料(分别为54例改良2厘米单孔、67例改良单孔加微小切口和53例传统单孔)。对三种手术方式进行回顾性比较,涉及安全性、可行性和术后疼痛情况。两组均未出现严重并发症和死亡病例。三组间的失血量、置管时间和住院时间相当(P>0.05)。2厘米单孔组和2厘米单孔加微小切口组在术后疼痛视觉模拟评分、伤口麻木、切口愈合及外观方面明显优于传统组(P<0.05),而这两组之间相当。值得注意的是,2厘米加微小切口组的手术时间短于2厘米组(P<0.05),且与传统单孔组相似。应用于VATS肺段切除术的2厘米改良单孔是可行且安全的,在术后疼痛、麻木及切口外观方面具有明显优势。增加微小切口后,可显著提高手术便利性且不增加疼痛。我们的研究结果可为VATS肺段切除术提供一种有前景的新切口模式。

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