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Title: [Application of uniportal video-assisted thoracoscopic surgery in the treatment of tuberculous destroyed lung].
Author: Jiang YH, Liu QB, Yao L, Dai XY.
Journal: Zhonghua Wai Ke Za Zhi; 2024 May 01; 62(5):432-437. PubMed ID: 38548613.
Abstract:
Objective: To examine the efficacy of uniportal video-assisted thoracoscopic surgery in the treatment of tuberculous destroyed lung. Methods: This is a retrospective case series study. The clinical data of 33 patients with tuberculous destroyed lung who had received uniportal video-assisted thoracoscopic pulmonary resection from June 2020 to May 2022 in Department of Surgery, Wuhan Pulmonary Hospital were retrospectively analyzed. There were 13 males and 20 females, aged (47.5±16.2) years (range: 19 to 68 years). The course of the disease was from 15 days to 8 years. All 33 cases had pleural adhesions, including 30 cases with total pleural adhesions and atresia. There were 21 cases of calcification of the thoracic lymph node, 17 cases of aspergillus infection, 4 cases of drug-resistant tuberculosis. The surgical incision was located at the midline of the fifth intercostal axilla, length 4 to 5 cm. The principle of separating pleural adhesions was easy first and difficult later, and then appropriate procedures were selected to resect the diseased lung based on the exploration situation. There were 12 cases that underwent superior lobectomy, 11 cases that underwent superior lobectomy and dorsal segmentectomy, 3 cases that underwent inferior lobectomy, 3 cases that underwent pneumonectomy, 2 cases that underwent middle and inferior lobectomy, and 1 case that underwent superior lobectomy, dorsal segmentectomy and basal segment wedgectomy. The surgical techniques, perioperative evaluation and treatment, management of complications, and the outcome were summarized. Results: Six cases were converted to thoracoscope assisted small incision or thoracotomy. For 27 cases who successfully underwent uniportal VATS, the operation time was (238.7±76.8) minutes (range: 60 to 420 minutes), the intraoperative bleeding was (400.4±315.9) ml (range: 50 to 1 200 ml). The duration of postoperative drainage was (12.7±8.3) days (range: 3 to 42 days). The postoperative hospital stay was (15.2±7.9) days (range: 6 to 43 days). Persistent postoperative pulmonary leakage occurred in 12 cases. There were 2 cases of active thoracic bleeding, one of which was cured with conservative treatment. The other case underwent secondary operation. One case of bronchopleural fistula was cured after continuous thoracic drainage to control infection and implantation of one-way bronchial valve through a fiberoptic bronchoscope. Conclusion: For selected patients with tuberculous destroyed lung, choosing the reasonable surgical procedures and techniques, the uniportal VATS could reduce surgical trauma. 目的： 探讨单孔胸腔镜手术治疗结核性毁损肺的临床效果和技术要点。 方法： 本研究为回顾性病例系列研究。回顾性分析2020年6月至2022年5月在武汉市肺科医院外科接受单孔胸腔镜肺切除术的33例结核性毁损肺患者的临床资料。男性13例，女性20例；年龄（47.5±16.2）岁（范围：19~68岁）。所有病例均有胸膜粘连，其中30例全胸膜腔粘连闭锁，21例有胸腔淋巴结钙化。17例合并曲霉菌感染，4例为耐药结核病。手术切口位于第5肋间腋中线处，长度4~5 cm。术中按照先易后难的原则松解胸膜粘连，根据探查情况选择合适的流程解剖和处理病肺。行上叶切除术12例，上叶切除+下叶背段切除术11例，下叶切除术3例，全肺切除术3例，中叶+下叶切除术2例，上叶切除+下叶背段切除+基底段楔形切除2例。总结分析手术操作技巧、围手术期评估和治疗、并发症处理及治疗效果等。 结果： 6例中转为胸腔镜辅助小切口或开胸手术，其中3例因肺门致密炎性粘连及钙化淋巴结嵌顿，术中损伤肺动脉导致出血而中转为胸腔镜辅助小切口手术；2例因胸腔炎症重，粘连松解后胸壁广泛渗血，中转开胸手术；1例左全肺切除术因纵隔移位、牵拉暴露困难而中转开胸手术。27例顺利完成单孔胸腔镜手术，手术时间（238.7±76.8）min（范围：60~420 min），术中出血量（400.4±315.9）ml（范围：50~1 200 ml），术后引流时间（12.7±8.3）d（范围：3~42 d），术后住院时间（15.2±7.9）d（范围：6~43 d）。术后发生持续性肺漏气12例；胸腔活动性出血2例，1例保守治疗治愈，1例行二次手术止血；支气管胸膜瘘1例持续胸腔引流控制感染后，经纤维支气管镜植入支气管单向活瓣后治愈。 结论： 对于严格选择的病例，运用合适的手术流程和技巧，单孔胸腔镜手术的手术结果、早期恢复和远期预后总体较好，可降低手术创伤。.

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