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目的总结单操作孔完全胸腔镜手术行非小细胞肺癌根治术中的经验。方法行单操作孔全胸腔镜下肺癌根治术60例,右上肺叶切除19例,右肺中叶切除4例,右下肺叶切除20例。左上肺叶切除12例,左肺下叶切除5例。胸腔镜观察孔取腋中线第7肋间,做2 cm左右切口,操作孔根据病灶部位选择第4或5肋间取腋前线至腋中线间,切口长约4~5 cm,经单操作孔完成肺癌根治术。结果全组患者手术顺利,无围手术期死亡患者,无严重术后并发症。清扫淋巴结平均(12.5±2.1)枚。平均手术时间(185.2±10.4)分钟。术中出血平均(150.5±30.6)ml。胸腔引流管拔除时间平均(3.5±1.5)天。术后住院时间平均(5.5±1.2)天。结论和传统腔镜手术比较,单操作孔减少了背部伤口,进一步减小创伤。单操作孔完全胸腔镜手术常规胸腔镜器械可完成,不需增加特殊器械。患者选择恰当并且按正确顺序操作,是单操作孔胸腔镜手术成功的重要保证。
Objective To summarize the experience of single-operation-hole complete thoracoscopic surgery in radical mastectomy for non-small cell lung cancer. Methods Underwent single thoracoscopic total thoracoscopic surgery for lung cancer in 60 cases, right upper lobe resection in 19 cases, right middle lobe resection in 4 cases, and right lower lobe resection in 20 cases. Left upper lobe resection in 12 cases, left lower lobe resection in 5 cases. The thoracoscopic observation hole is taken from the 7th intercostal space in the midline of the orbital iliac crest, and a 2 cm incision is made. The operation hole is selected between the 4th or 5th intercostal space from the intercostal space to the midline of the midaxillary line. The incision length is about 4-5 cm, and the operation hole is single. Complete lung cancer resection. Results The patients in the whole group performed smoothly without any death in the perioperative period. No serious postoperative complications occurred. The average number of lymph node dissections was 12.5±2.1. The average operation time was (185.2±10.4) minutes. The average intraoperative blood loss was (150.5±30.6) ml. The average length of chest tube removal was (3.5 ± 1.5) days. The average hospital stay was (5.5 ± 1.2) days. Conclusions Compared with conventional laparoscopic surgery, a single manipulation hole reduces back wounds and further reduces trauma. Complete thoracoscopic surgery with a single operating hole can be performed with conventional thoracoscopic instruments without the need for special instruments. Choosing the right patient and operating in the correct sequence is an important guarantee for the success of single-operation thoracoscopic surgery.