肺癌外科手术切口的演变与发展趋势

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Abstract

微创、安全以及无瘤原则，是影响肺癌外科手术切口选择的最重要因素，从现有经验来看，把握手术指征，选择恰当的切口，掌握微创手术技巧，各种微创全胸腔镜手术均是安全可靠的切口入路，但如果术中无法满足安全或无瘤原则，应果断更改为开胸手术；开胸手术入路仍是肺癌外科治疗的基石，特别是应用于中央型病灶以及复杂肺癌外科手术。单孔VATS技术与3D胸腔镜、经自然孔道内镜技术、虚拟现实可视化技术以及机器人VATS技术的结合，是肺癌外科手术切口未来发展的方向。

Translated abstract

Minimally invasive, safe and tumor-free are the main principles of the choice of surgical incision in lung cancer surgery. In recent years, with the advances in minimally invasive techniques, single-port video assisted thoracic surgery (VATS), robot-assisted thoracoscopic (RATS), suboxiphoid single-port VATS, simultaneous bilateral VATS pulmonary resection, are emerging approaches, single-port VATS has become one of the most exciting new developments in minimally invasive thoracic surgery in recent years. This paper reviews the evolution and trends of surgical incision in lung cancer surgery.

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Most cited references 33

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Uniportal VATS wedge pulmonary resections.

Eliseo Passera, Antonio Martin-Ucar, Antonio Martín-Navarro (2004)

Since 2000, 15 patients have undergone single port (uniportal) video-assisted thoracic surgery for wedge pulmonary resection either for diagnosis of interstitial lung diseases (10 patients) or for treatment of primary spontaneous pneumothoraces (5 patients). Diagnosis was obtained in all patients and no recurrences of pneumothorax were seen at follow-up. This initial experience shows that, for specific indications, uniportal video-assisted thoracic surgery for wedge pulmonary resections can be safe and effective.

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Single-port video-assisted thoracoscopic lobectomy.

Diego Gonzalez, Marina Paradela, José David García … (2011)

The video-assisted thoracoscopic surgery (VATS) approach to lobectomy for non-small cell lung cancer varies among hospitals. Although three to four incisions are usually made, the operation may be successfully carried out using only two incisions with similar results. We observed that for lower lobes the second incision could be eliminated in selected cases. We describe a case report of a 74-year-old female operated by a single-port approach for a lower-lobe VATS lobectomy.

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Uniportal video-assisted thoracoscopic lobectomy: two years of experience.

Lucía Méndez, Eva Trigo, D Rivas … (2013)

A video-assisted thoracoscopic approach to lobectomy varies among surgeons. Typically, 3 to 4 incisions are made. Our approach has evolved from a 3-port to a 2-port approach to a single 4- to 5-cm incision with no rib spreading. We report results with single-incision video-assisted thoracic major pulmonary resections during our first 2 years of experience. In June 2010, we began performing video-assisted thoracoscopic lobectomies through a uniportal approach (no rib spreading). By July 12, 2012, 102 patients had undergone this single-incision approach. Of 102 attempted major resections, 97 were successfully completed with a single incision (operations in 3 patients were converted to open surgery and 2 patients needed 1 additional incision). Five uniportal pneumonectomies were not included in the study. We have analyzed early outcomes of successful uniportal lobectomies (92 patients studied). Right upper lobectomy was the most frequent resection (28 cases). Mean surgical time was 154.1 ± 46 minutes (range, 60-310 minutes), mean number of lymph nodes was 14.5 ± 7 (range, 5-38 nodes), and mean number of explored nodal stations was 4.6 ± 1.2 (range, 3-8 stations). The mean tumor size was 2.8 ± 1.5 cm (0-6.5 cm). The median duration of time a chest tube was in place was 2 days and the median length of hospital stay was 3 days. There were complications in 14 patients; no postoperative 30-day mortality was reported. Single-incision video-assisted thoracoscopic anatomic resection is a feasible and safe procedure with good perioperative results, especially when performed by surgeons experienced with the double-port technique and anterior thoracotomy. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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Author and article information

Contributors

姜格宁 JIANG Gening

Journal

Journal ID (nlm-ta): Zhongguo Fei Ai Za Zhi

Journal ID (iso-abbrev): Zhongguo Fei Ai Za Zhi

Journal ID (publisher-id): ZGFAZZ

Title: Chinese Journal of Lung Cancer

Publisher: 中国肺癌杂志编辑部 (天津市和平区南京路228号300020 )

ISSN (Print): 1009-3419

ISSN (Electronic): 1999-6187

Publication date (Print): 20 June 2016

Volume: 19

Issue: 6

Pages: 343-346

Affiliations

[ ] 200433 上海，同济大学附属上海市肺科医院胸外科 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China

Author notes

姜格宁, Gening JIANG, E-mail: jgnwp@ 123456aliyun.com

Article

Publisher ID: zgfazz-19-6-343

DOI: 10.3779/j.issn.1009-3419.2016.06.08

PMC ID: 6015205

PubMed ID: 27335293

SO-VID: ce5a26a2-0862-4006-b3ff-094404ac599d

License:

This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0) License. See: https://creativecommons.org/licenses/by/3.0/

History

Date received : 1 June 2016

Date revision received : 7 June 2016

Date accepted : 10 June 2016

Funding

Funded by: 2015年上海市浦江人才计划

Award ID: 15PJD034

Funded by: 上海卫生系统重要疾病联合攻关项目（重大项目）

Award ID: 2013ZYJB0401

Funded by: 上海卫生系统先进适宜技术推广项目

Award ID: 2013SY023

Funded by: the grants from Shanghai Pujiang Program

Award ID: 15PJD034

Funded by: Shanghai Municipal Health Bureau United Research Projects for Vital Disease

Award ID: 2013ZYJB0401

Funded by: Shanghai Promotion Project of Advanced Technologies for Health System

Award ID: 2013SY023

本文受2015年上海市浦江人才计划（No.15PJD034）、上海卫生系统重要疾病联合攻关项目（重大项目）（No.2013ZYJB0401）及上海卫生系统先进适宜技术推广项目（No.2013SY023）资助

This paper was supported by the grants from Shanghai Pujiang Program (to Dong XIE)(No.15PJD034), Shanghai Municipal Health Bureau United Research Projects for Vital Disease (to Gening JIANG)(No.2013ZYJB0401), Shanghai Promotion Project of Advanced Technologies for Health System (to Gening JIANG)(No.2013SY023)

肺癌外科手术切口的演变与发展趋势 Translated title: Evolution and Development Trend of Lung Cancer Surgical Incision

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Most cited references 33

Uniportal VATS wedge pulmonary resections.

Single-port video-assisted thoracoscopic lobectomy.

Uniportal video-assisted thoracoscopic lobectomy: two years of experience.

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