本文選題：單孔胸腔鏡　切入點：肺葉切除　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討單孔胸腔鏡手術(shù)(Uniportal video-assisted thoracoscopic surgery,Uniportal VATS)在治療肺部疾病中的可行性及安全性,為其在臨床上的推廣使用提供依據(jù)。方法:收集我科于2015年1月至2016年2月采用單孔胸腔鏡手術(shù)治療肺部疾病的病例,統(tǒng)計分析全組單孔VATS的手術(shù)時間、術(shù)中出血、術(shù)后留置胸管時間、術(shù)后住院時間、術(shù)后并發(fā)癥等圍手術(shù)期臨床指標(biāo),并且對所有患者進(jìn)行定期術(shù)后隨訪。結(jié)果:全組共開展了69例單孔腔鏡手術(shù),病種包括非小細(xì)胞肺癌、自發(fā)性氣胸、肺隔離癥、支氣管擴(kuò)張等8種疾病。按手術(shù)方式分為2種,行肺葉切除29例,肺局部切除40例;肺局部切除包括肺大泡切除及肺楔形切除,肺大泡切除28例,肺楔形切除12例。行肺葉切除29例,肺葉切除手術(shù)時間170±32min,術(shù)中出血205±145ml,術(shù)后留置胸管3.7±2.1天,平均術(shù)后住院8.3±3.1天,術(shù)中1例在游離動脈鞘時因為門釘淋巴結(jié)粘連緊密而造成動脈壁破裂出血而被迫中轉(zhuǎn)開胸,其余行肺葉切除手術(shù)均未中轉(zhuǎn),肺葉切除中轉(zhuǎn)率1/29(3.4%),行肺葉切除術(shù)后8例合并胸腔積液需再次處理。肺局部切除共40例,平均手術(shù)時間64±32min,術(shù)中出血68±23ml,腔引流管留置時間3.0±1.9天,術(shù)后住院時間5.7±1.8天,肺局部切除40例均未中轉(zhuǎn),1例行肺大泡切除患者術(shù)后出現(xiàn)持續(xù)性漏氣,經(jīng)保守治療后痊愈,其他患者恢復(fù)順利。全組無其他嚴(yán)重并發(fā)癥及圍手術(shù)死亡,隨訪3~12月均恢復(fù)良好,全組患者恢復(fù)良好,氣胸患者無復(fù)發(fā)。結(jié)論:通過對我科單孔VATS手術(shù)的統(tǒng)計,可以發(fā)現(xiàn)單孔胸腔鏡在治療肺部疾病中是安全可行的,全組69例手術(shù)中,僅1例發(fā)生中轉(zhuǎn),其余手術(shù)均能在單孔下順利完成。就病種而言,全組包括8種肺部疾病,有肺良性疾病,也有肺部惡性腫瘤,均能在單孔下完成操作,因此單孔VATS在多種肺部疾病中均可以得到使用。就手術(shù)方式而言,主要包括兩種,相對簡單的肺局部切除未有中轉(zhuǎn),取得效果滿意;而相對復(fù)雜的肺葉切除,也能在單孔下順利完成,因此單孔VATS可開展的手術(shù)方式可多種多樣。就我們經(jīng)驗而言,單孔VATS手術(shù)操作較傳統(tǒng)腔鏡技術(shù)(conventional video-assisted thoracoscopic surgery,c-VATS)對術(shù)者的要求更高。因此需要通過一定的學(xué)習(xí),才能完全掌握,學(xué)習(xí)過程中應(yīng)先易后難,應(yīng)先掌握相對較簡單的手術(shù)方式,再嘗試相對復(fù)雜的,能夠提高手術(shù)的安全性。如果術(shù)者在掌握一定的傳統(tǒng)胸腔鏡技術(shù)之上,掌握單孔腔鏡技術(shù)將變得更加容易。就手術(shù)效果而言,單孔VATS手術(shù)效果滿意,全組患者在圍手術(shù)期及術(shù)后隨訪中均未出現(xiàn)較嚴(yán)重并發(fā)癥,而且較c-VATS創(chuàng)傷更小、術(shù)后疼痛更輕、更加美觀,是一種更加微創(chuàng)的手術(shù)方式。因此單孔VATS值得在臨床上推廣。
[Abstract]:Objective: to investigate the feasibility and safety of single hole thoracoscopic surgery (video-assisted thoracoscopic Surgeryus Uniportal VATS) in the treatment of pulmonary diseases. Methods: from January 2015 to February 2016, we collected the patients who were treated with single hole thoracoscopic surgery for pulmonary diseases, and analyzed the operative time and intraoperative bleeding of the whole group of single hole VATS. All the patients were followed up regularly. Results: 69 cases of single hole endoscopic surgery were performed in the whole group, including non-small cell lung cancer (NSCLC). Spontaneous pneumothorax, pulmonary sequestration, bronchiectasis and other 8 kinds of diseases. According to the operation method, there are 2 kinds of diseases. There are 29 cases of lobectomy, 40 cases of local resection of lung, 28 cases of pneumonectomy including alveolar resection and wedge resection of lung, 28 cases of alveolar resection. Pulmonary wedge resection was performed in 29 cases. The operative time of lobectomy was 170 鹵32 min, the intraoperative bleeding was 205 鹵145 ml, the mean hospitalization was 8.3 鹵3.1 days, and the postoperative indwelling chest tube was 3.7 鹵2.1 days. One case was forced to open chest because of the close adhesion of portal nail lymph nodes during the free arterial sheath, and the others underwent lobectomy. The conversion rate of lobectomy was 1 / 29 ~ 3.4%, and 8 cases with pleural effusion after lobectomy needed to be retreated. The average operative time was 64 鹵32 min, the average operative time was 64 鹵32 min, the intraoperative bleeding was 68 鹵23 ml, the retention time of drainage tube was 3.0 鹵1.9 days, and the postoperative hospitalization time was 5.7 鹵1.8 days. In all 40 cases of local pneumonectomy, 1 patient with pulmonary alveolectomy had sustained air leakage, recovered after conservative treatment, and the other patients recovered smoothly. There were no other serious complications and perioperative death in the whole group. All the patients were followed up for 3 to 12 months. Conclusion: through the statistics of single hole VATS operation in our department, we can find that single hole thoracoscopy is safe and feasible in the treatment of pulmonary diseases. The rest of the operations can be performed successfully under a single hole. As far as diseases are concerned, the whole group includes 8 kinds of lung diseases, including benign lung diseases and malignant lung tumors, all of which can be performed under a single hole. So the single hole VATS can be used in many kinds of lung diseases. As far as the operation method is concerned, there are mainly two kinds of operation, the relatively simple local resection of the lung has not been transferred, and the result is satisfactory, while the relatively complicated lobectomy, The single hole VATS can be performed in a variety of ways. In our experience, the single hole VATS procedure is more demanding than the conventional video-assisted thoracoscopic surgery-c-VATS (conventional video-assisted thoracoscopic Surgery-c-VATS). In order to fully master, the learning process should be easier than before, should first master a relatively simple operation, and then try a relatively complex, can improve the safety of the operation, if the operator is in the possession of certain traditional thoracoscopic technology, It will be easier to master the technique of single hole endoscopy. In terms of the effect of single hole VATS, there are no serious complications, less trauma and less postoperative pain in the whole group during perioperative period and postoperative follow-up. More beautiful, is a more minimally invasive operation, so single-hole VATS is worthy of clinical promotion.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R655.3

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