南方医科大学学报

南方医科大学学报 ›› 2023, Vol. 43 ›› Issue (7): 1254-1258.doi: 10.12122/j.issn.1673-4254.2023.07.23

• • 上一篇    

同期双侧胸腔镜手术在双肺多发肺结节外科治疗中的应用价值

张书新，赵亚超，周爱国，刘慧峰，郑梦利   

  1. 解放军总医院第八医学中心呼吸与危重症医学部胸外科，北京 100091
  • 出版日期:2023-07-20 发布日期:2023-07-20

Feasibility and safety of one-stage bilateral video- assisted thoracic surgery for resection of bilateral multiple pulmonary nodules

ZHANG Shuxin, ZHAO Yachao, ZHOU Aiguo, LIU Huifeng , ZHENG Mengli   

  1. Department of Thoracic Surgery, Senior Department of Respiratory and Critical Care Medicine, Eighth Medical Center of PLA General Hospital, Beijing 100091, China
  • Online:2023-07-20 Published:2023-07-20

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摘要： 目的 探讨同期双侧胸腔镜手术（VATS）治疗双肺多发肺结节的可行性和安全性。方法 选取2011年7月~2021年8月在我科行同期双侧VATS治疗的双肺多发肺结节患者41例，分析其临床特征、病理学特征以及围手术期结局，并定期随访。结果 本组41例患者行双侧VATS手术，其中1 例中转开胸，手术方式包括双侧肺叶切除2例（4.9%）、单侧肺叶切除加对侧亚肺叶切除15例（36.6%）和双侧亚肺叶切除24例（58.5%）。手术时间：196.3±54.5 min，失血量：224.6±139.5 mL，胸管留置时间：4.7±1.1 d，住院时间：14±3.8 d。41例患者中有15例为双侧原发性肺癌，21例为单侧原发性肺癌，5例为双侧良性病变；共发现双侧肺部结节112个，其中恶性67个、良性45个。术后出现5例肺部感染、2例呼吸衰竭、2例哮喘发作、2例房颤和1例药物性肝损伤，无围手术期死亡。术后1年生存率为97.6%。结论 经过严密的术前评估和精细的围手术期管理，同期双侧胸腔镜手术用于治疗双肺多发肺结节是安全、可行的。

关键词: 胸腔镜手术；同期双侧胸腔镜手术；肺癌；双肺多发肺结节

Abstract: Objective To evaluate the feasibility and safety of one- stage bilateral video-assisted thoracic surgery (VATS) for resection of bilateral multiple pulmonary nodules (BMPNs). Methods We analyzed the clinical characteristics, pathological features, perioperative outcomes and follow-up data of 41 patients with BMPNs undergoing one-stage bilateral VATS from July, 2011 to August, 2021. Results One-stage bilateral VATS was performed uneventfully in 40 of the patients, and conversion to open surgery occurred in 1 case. The surgical approaches included bilateral lobectomy (4.9% ), lobar-sublobar resection (36.6%) and sublobar-sublobar resection (58.5%) with a mean operative time of 196.3±54.5 min, a mean blood loss of 224.6±139.5 mL, a mean thoracic drainage duration of 4.7 ± 1.1 days and a mean hospital stay of 14 ± 3.8 days. Pathological examination revealed bilateral primary lung cancer in 15 cases, unilateral primary lung cancer in 21 cases and bilateral benign lesions in 5 cases. A total of 112 pulmonary nodules were resected, including 67 malignant and 45 benign lesions. Postoperative complications included pulmonary infection (5 cases), respiratory failure (2 cases), asthma attack (2 cases), atrial fibrillation (2 cases), and drug-induced liver injury (1 case). No perioperative death occurred in these patients, who had a 1-year survival rate of 97.6%. Conclusion With appropriate preoperative screening and perioperative management, one-stage bilateral VATS is feasible and safe for resection of BMPNs.

Key words: video-assisted thoracic surgery; one-stage bilateral video-assisted thoracic surgery; lung cancer; bilateral multiple pulmonary nodules