3D-CTBA及3D-VATS单操作孔行解剖性肺段切除治疗非小细胞肺癌

BACKGROUND AND OBJECTIVE: China is a high-incidence area of lung cancer, and its morbidity and mortality were the highest in malignant tumors. At present, the popularization of low-dose computed tomography (CT) examination has significantly improved the detection rate of early lung cancer, anatomical segmentectomy is currently widely used early in non-small cell lung cancer (NSCLC) and those who cannot tolerate lobectomy in patients with lung cancer. However, the anatomical structure of segment and its surgical operation is relatively complex, lead to segmentectomy has a high risk and difficulty. We performed anatomical segmentectomy by use of combining three-dimensional computed tomography bronchography and angiography (3D-CTBA) and three-dimensional video-assisted thoracic surgery (3D-VATS) single-operation-hole minimally invasive surgery in the treatment of NSCLC to investigate its clinical effect, and evaluate its clinical relevant feasibility and theoretical basis. METHODS: We carried out a retrospective review of the 57 cases by use of combining 3D-CTA in preoperative and 3D-VATS single-operation-hole anatomical segmentectomy in intraoperative in the treatment of NSCLC performed in Department of Thoracic Surgery, the First Affiliated Hospital of Soochow University from October 2015 to April 2017. RESULTS: The whole group was successfully performed by use of VATS without anyone conversion to thoracotomy. The mean operation time was (142.2±28.3) min, and the mean blood loss was (93.8±46.5) mL. The mean number of lymph node dissection was (9.1±2.2), and the mean postoperative thoracic drainage was (429.8±181.2) mL. The postoperative retention of chest tube time was (2.8±1.1) d. The mean hospitalization time was (5.2±1.3) d. The postoperative pathology showed 9 cases with benign lesions, accounting for 15.7%, 48 cases with malignant lesions, accounting for 84.2%. Postoperative complications: pulmonary infection in 3 cases (5.2%), atelectasis in 1 case (1.9%), small amount of hemoptysis in 1 case (1.9%), lung leakage > 3 d in 2 cases (3.5%). Arrhythmia in 4 cases (7.0%). The patients were followed up for 10 months. No complications occurred such as bronchial pleural fistula, chylothorax, encapsulated pleural effusion and those patients were followed up without recurrence and distant metastasis. CONCLUSION: The use of combining 3D-CTBA and 3D-VATS single-operation-hole to anatomical segmentectomy is safe and effective in the treatment of NSCLC and is suitable for early non-small cell lung cancer, especially those can not tolerate lobectomy.