Résumé
ObjectiveTo explore the feasibility and safety of uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy in the treatment of benign and malignant small lung lesions. MethodsA retrospective analysis was conducted on the clinical data of 395 patients with small pulmonary lesions undergoing uniportal videoassisted thoracoscopic anatomic pulmonary segmentectomy by a single surgery group between Aug. 2013 and May 2017 in Shanghai Pulmonary Hospital of Tongji University. Among them, there were 139 males and 256 females, with a mean age of (56.25±10.53) years, and 193 left lung lesions and 202 right lung lesions. The double-lumen trachea cannula was performed under general anesthesia. Thoracoscopy and surgical instruments were inserted through a 4 cm single-hole incision in the 4th or 5th intercostal of anterior line axillary, and anatomical segmentectomy was performed. The perioperative data, postoperative pathology, intraoperative open thoracotomy transit, postoperative complications and long-term follow-up results were statistically analyzed. ResultsOf the 395 patients, 7 patients were converted to lobectomy, 3 to thoracotomy, 1 to basal pulmonary segmentectomy from posterior basal pulmonary segment, and all the other patients were successfully completed. There were no significant differences in the operation time, intraoperative blood loss, lesion diameter, number of lymph node samples, thoracic drainage at 24 h after operation, postoperative thoracic drainage tube insertion time or postoperative hospital stay between left and right lung lesions (all P>0.05). Postoperative pathology showed malignant lesions in 310 cases and benign lesions in 85 cases. Postoperative complications occurred in 11 cases (6 cases of left lung and 5 cases of right lung), including 2 cases of hemothorax, 6 cases of delayed leakage, and 3 cases of arrhythmia. There were no operative death. The average follow-up time was (40.06±2.86) months, ranging from 9 to 54 months. There were no long-term complications, no abnormal cardiopulmonary function and no recurrence or metastasis in patients with malignant tumors. Conclusion The uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy is safe and feasible, and can resect lesions accurately and minimally invasively. And thus it is worthy of clinical application.