本文選題：D-CT　切入點：支氣管血管成像　出處：《中國肺癌雜志》2017年09期

【摘要】：背景與目的中國是肺癌高發(fā)地區(qū),其發(fā)病率及死亡率在惡性腫瘤中均占首位。目前低劑量CT檢查的普及使早期肺癌檢出率顯著提高,解剖性肺段切除目前廣泛應(yīng)用于Ia期非小細(xì)胞肺癌(non-small cell lung cancer,NSCLC)及不能耐受肺葉切除肺癌患者。但因肺段解剖結(jié)構(gòu)及手術(shù)操作相對復(fù)雜,使得其具有較高的手術(shù)風(fēng)險與難度。我們應(yīng)用三維計算機(jī)斷層掃描支氣管血管成像(three-dimensional computed tomography bronchography and angiography,3D-CTBA)及三維電視輔助胸部外科技術(shù)(three-dimensional video-assisted thoracic surgery,3D-VATS)單操作孔行解剖性肺段切除微創(chuàng)手術(shù)技術(shù)治療NSCLC,以探討其臨床效果,為其臨床應(yīng)用提供相關(guān)可行性及理論依據(jù)。方法回顧性分析蘇州大學(xué)附屬第一人民醫(yī)院胸外科2015年10月-2017年04月共施行57例術(shù)前對肺部病灶予以3D-CTBA重建以及術(shù)中應(yīng)用3D-VATS單操作孔進(jìn)行解剖性肺段切除治療NSCLC病例。結(jié)果全組均全腔鏡下順利完成,無中轉(zhuǎn)開胸。手術(shù)時間平均(142.2±28.3)min,術(shù)中出血量平均(93.8±46.5)m L。平均淋巴結(jié)清掃數(shù)目(9.1±2.2)個,術(shù)后胸腔引流量平均(429.8±181.2)m L。術(shù)后留置胸管時間(2.8±1.1)d。平均住院時間(5.2±1.3)d。術(shù)后病理示良性病變9例,約占15.7%,惡性病變48例,約占84.2%。術(shù)后并發(fā)癥:肺部感染3例(5.2%),肺不張1例(1.7%),少量咯血1例(1.7%),肺漏氣2例(3 d,3.5%),心律失常4例(7.0%)。術(shù)后平均隨訪10個月,無支氣管胸膜瘺、乳糜胸、包裹性胸腔積液等并發(fā)癥,隨訪患者中無復(fù)發(fā)及遠(yuǎn)處轉(zhuǎn)移病例。結(jié)論應(yīng)用3D-CTBA及3D-VATS單操作孔行解剖性肺段切除治療NSCLC的安全有效,適用于早期NSCLC以及不能耐受肺葉切除患者。
[Abstract]:Background & objective China is a high incidence area of lung cancer, its morbidity and mortality are the first in malignant tumors. The prevalence of low dose CT examination has significantly increased the detection rate of early lung cancer. Anatomical segmental resection is widely used in patients with stage Ia non-small cell lung cancer (NSCLC) and lung lobectomy. We used three-dimensional computed tomography bronchography and angiography3D-CTBAand three-dimensional video-assisted thoracic surery3D-VATSto perform anatomical pulmonary segmental resection with three-dimensional computed tomography bronchography and angiography3D-CTBAand three-dimensional video-assisted thoracic surgery technique. In order to investigate the clinical effect of NSCLC, the minimally invasive surgical technique was used to treat NSCLC. Methods retrospective analysis was performed on 57 cases of preoperative 3D-CTBA reconstruction of pulmonary lesions in the first people's Hospital affiliated to Suzhou University from October 2015 to April 2017. The anatomical segmental resection of NSCLC was performed with 3D-VATS single operating foramen. Results all patients with NSCLC were successfully treated by endoscopy. The mean operative time was 142.2 鹵28.3 min, the average amount of intraoperative bleeding was 93.8 鹵46.5 min, the average number of lymph nodes dissected was 9.1 鹵2.2), the mean postoperative thoracic drainage volume was 429.8 鹵181.2 mm / L, the mean time of indwelling thoracic tube was 2.8 鹵1.1 d, the average hospitalization time was 5.2 鹵1.3 d. The pathological changes were benign in 9 cases. Postoperative complications: pulmonary infection in 3 cases, pulmonary infection in 1 case, atelectasis in 1 case, hemoptysis in 1 case, hemoptysis in 1 case, pulmonary leakage in 2 cases in 3 days, arrhythmia in 4 cases, postoperative mean follow-up for 10 months, no bronchopleural fistula, chylothorax, There were no recurrence or distant metastasis in the patients with encapsulated pleural effusion and other complications. Conclusion 3D-CTBA and 3D-VATS single hole dissecting pneumonectomy is safe and effective in the treatment of NSCLC. It is suitable for the patients with early NSCLC and intolerable lobectomy.
【作者單位】： 蘇州大學(xué)附屬第一人民醫(yī)院胸外科;南京醫(yī)科大學(xué)附屬蘇州市立醫(yī)院北區(qū)胸外科;蘇州大學(xué)附屬第一人民醫(yī)院放射科;
【分類號】：R734.2

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本文編號：1667009