市级医院胸腔镜微创技术治疗胸部疾病
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摘要
目的探讨市级医院开展胸腔镜微创技术治疗胸部疾病的安全性、可行性及学习曲线。方法回顾性分析2009年9月至2016年9月四川省内江市第一人民医院胸外科行胸腔镜手术591例患者的临床资料,男378例、女213例,年龄14~82岁。结果所有患者均顺利完成手术,其中中转开胸12例,中转率2.0%;术后共出现严重并发症24例(4.1%);围手术期死亡4例,死亡率0.7%。胸腔镜肺癌根治术学习曲线约为25例,胸腹腔镜联合食管癌根治术学习曲线约为15例。结论市级医院开展胸腔镜微创技术安全、可行,有推广价值。
Objective To explore the safety,feasibility and learning curve of video-assisted thoracoscopic surgery(VATS) in treatment of thoracic diseases.Method We retrospectively analyzed the clinical data of 591 patients of thoracic surgery in our hospital between September 2009 and September 2016.There were 378 males and 213 females at age of 14–82 years.Result All patients were successfully completed surgery.Twelve patients converted to open chest with conversion rate of 2.0%.Postoperative complications occurred in 24 patients(4.1%).Four patients died during the perioperative period,and mortality rate was 0.7%.The learning curve of VATS for lung cancer was about 25 patients.And the learning curve of video-assisted laparoscopy for resection of esophageal cancer was about 15 patients.Conclusion VATS is safety and feasible for the chest disease patients in municipal hospital,and is worthy to popularize.
Objective To explore the safety,feasibility and learning curve of video-assisted thoracoscopic surgery(VATS) in treatment of thoracic diseases.Method We retrospectively analyzed the clinical data of 591 patients of thoracic surgery in our hospital between September 2009 and September 2016.There were 378 males and 213 females at age of 14–82 years.Result All patients were successfully completed surgery.Twelve patients converted to open chest with conversion rate of 2.0%.Postoperative complications occurred in 24 patients(4.1%).Four patients died during the perioperative period,and mortality rate was 0.7%.The learning curve of VATS for lung cancer was about 25 patients.And the learning curve of video-assisted laparoscopy for resection of esophageal cancer was about 15 patients.Conclusion VATS is safety and feasible for the chest disease patients in municipal hospital,and is worthy to popularize.
引文
1丁凯,周晓燕,吕剑,等.完全电视胸腔镜手术在胸部疾病诊疗中的应用.山东医药,2015,55(1):84-85.
2支修益,石远凯,于金明.中国原发性肺癌诊疗规范(2015年版).中华肿瘤杂志,2015,37(1):67-68.
3方文涛,傅剑华,沈毅,等.胸腺肿瘤的诊疗:基于中国胸腺肿瘤协作组多中心回顾性研究的共识.中国肺癌杂志,2016,17(7):414-417.
4殷章居,李国仁.食管癌外科的风险因素、评估及对策的思考.中国胸心血管外科临床杂志,2016,23(9):851-858.
5周志国,甄婵军,梁军利,等.食管癌AJCC/UICC第6、7版TNM分期分段方法在放疗患者中的比较.肿瘤防治研究,2015,42(8):772-776.
6蒲强,马林,车国卫,等.单向式胸腔镜肺叶切除安全性及技术可行性研究-附1 040例报告.四川大学学报(医学版),2013,44(1):109-113.
7杜恒,廖虎,宋志芳,等.胸腔镜手术在中国地市级医院胸外科应用现状的问卷调查.中国胸心血管外科临床杂志,2013,20(3):347-351.
8黄荣金,林炳煌.胸腔镜肺叶切除术扶镜技术的配合.中国胸心血管外科临床杂志,2016,23(4):411-413.
9Tulay CM,Ozsoy IE.spontaneous pneumothorax recurrence and surgery.Indian J Surg,2015,77(2):463-465.
10李华伟,张兴博,赵宁,等.胸腔镜手术下治疗原发性自发性气胸的临床疗效及复发因素分析.中国胸心血管外科临床杂志,2016,23(7):692-697.
11Hatz RA,Kaps MF,Meimarakis G,et al.Long-term results after video-assisted thoracoscopic surgery for first-time and recurrent spontaneous pneumothorax.Ann Thorac Surg,2000,70(1):253.
12李运,杨帆,赵辉,等.全胸腔镜肺叶切除术中转开胸的淋巴结影响.中华胸心血管外科杂志,2013,29(10):591-594.
13Mu JW,Gao SH,Huang GF,et al.A propensity matched comparison of effects between video assisted thoracoscopic singleport,two-port and three-port pulmonary resection on lung cancer.J Thorac Dis,2016,8(7):1469-1476.
14Cerfolio RJ,Bryant AS,Skylizard L,et al.Optimal technique for the removal of chest tubes after pulmonary resection.J Thorac Cardiovasc Surg,2013,145(6):1535-1539.
15施庆彤,范黄新,刁亚利.管状胃宽度与食管癌术后抗胃食管反流的临床研究.中华胸部外科电子杂志,2016,3(1):25-28.
16胡文滕,蔡谦谦,蔺瑞江,等.食管胃侧侧吻合对术后并发症影响的系统评价与Meta分析.中国胸心血管外科临床杂志,2016,23(3):224-229.
17卢强,李小飞,陈召,等.新型“三孔式”微创术式治疗重症肌无力.中华胸心血管外科杂志,2016,32(5):287-288.
18许建功,蔡瑞君.胸腔镜联合腹腔镜食管癌根治术学习曲线研究.中国全科医学,2012,15(6):631-634.
2支修益,石远凯,于金明.中国原发性肺癌诊疗规范(2015年版).中华肿瘤杂志,2015,37(1):67-68.
3方文涛,傅剑华,沈毅,等.胸腺肿瘤的诊疗:基于中国胸腺肿瘤协作组多中心回顾性研究的共识.中国肺癌杂志,2016,17(7):414-417.
4殷章居,李国仁.食管癌外科的风险因素、评估及对策的思考.中国胸心血管外科临床杂志,2016,23(9):851-858.
5周志国,甄婵军,梁军利,等.食管癌AJCC/UICC第6、7版TNM分期分段方法在放疗患者中的比较.肿瘤防治研究,2015,42(8):772-776.
6蒲强,马林,车国卫,等.单向式胸腔镜肺叶切除安全性及技术可行性研究-附1 040例报告.四川大学学报(医学版),2013,44(1):109-113.
7杜恒,廖虎,宋志芳,等.胸腔镜手术在中国地市级医院胸外科应用现状的问卷调查.中国胸心血管外科临床杂志,2013,20(3):347-351.
8黄荣金,林炳煌.胸腔镜肺叶切除术扶镜技术的配合.中国胸心血管外科临床杂志,2016,23(4):411-413.
9Tulay CM,Ozsoy IE.spontaneous pneumothorax recurrence and surgery.Indian J Surg,2015,77(2):463-465.
10李华伟,张兴博,赵宁,等.胸腔镜手术下治疗原发性自发性气胸的临床疗效及复发因素分析.中国胸心血管外科临床杂志,2016,23(7):692-697.
11Hatz RA,Kaps MF,Meimarakis G,et al.Long-term results after video-assisted thoracoscopic surgery for first-time and recurrent spontaneous pneumothorax.Ann Thorac Surg,2000,70(1):253.
12李运,杨帆,赵辉,等.全胸腔镜肺叶切除术中转开胸的淋巴结影响.中华胸心血管外科杂志,2013,29(10):591-594.
13Mu JW,Gao SH,Huang GF,et al.A propensity matched comparison of effects between video assisted thoracoscopic singleport,two-port and three-port pulmonary resection on lung cancer.J Thorac Dis,2016,8(7):1469-1476.
14Cerfolio RJ,Bryant AS,Skylizard L,et al.Optimal technique for the removal of chest tubes after pulmonary resection.J Thorac Cardiovasc Surg,2013,145(6):1535-1539.
15施庆彤,范黄新,刁亚利.管状胃宽度与食管癌术后抗胃食管反流的临床研究.中华胸部外科电子杂志,2016,3(1):25-28.
16胡文滕,蔡谦谦,蔺瑞江,等.食管胃侧侧吻合对术后并发症影响的系统评价与Meta分析.中国胸心血管外科临床杂志,2016,23(3):224-229.
17卢强,李小飞,陈召,等.新型“三孔式”微创术式治疗重症肌无力.中华胸心血管外科杂志,2016,32(5):287-288.
18许建功,蔡瑞君.胸腔镜联合腹腔镜食管癌根治术学习曲线研究.中国全科医学,2012,15(6):631-634.