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1、單孔胸腔鏡技術(shù)治療進(jìn)展河南大學(xué)第一附屬醫(yī)院胸心血管外科 楊忠信Wechat:18737821895 v經(jīng)胸單孔胸腔鏡治療進(jìn)展v經(jīng)劍突下單孔胸腔鏡治療進(jìn)展v病例分享 Uniportal History:單孔內(nèi)鏡下手汗癥治療v自1995年1月100例患者（46例女性、54例男性）接收雙側(cè)單孔內(nèi)鏡下手汗癥治療。v雙側(cè)同期在30分鐘內(nèi)完成v 96%患者順利康復(fù)并第2天出院 v手術(shù)時(shí)間、住院時(shí)間縮短、療效均優(yōu)于開(kāi)放手術(shù) Vanaclocha.Uniportal endoscopic superior thoracic sympathectomy. Neurosurgery.2000 Apr;46(4):
2、924-8. Uniportal History:經(jīng)肋間單孔胸腔鏡下肺楔形切除 Gaetano Rocco. Uniportal VATS wedge pulmonary resections.The Annals of Thoracic Surgery. 2004 Feb;77(2):726-8. v自2000年15例患者，其中10例不明原因肺間質(zhì)病變，5例自發(fā)性氣胸患者v行單孔胸腔鏡下肺楔形切除v肺間質(zhì)病變患者均明確診斷，氣胸患者無(wú)復(fù)發(fā)v單孔胸腔鏡手術(shù)行肺楔形切除是安全有效的 Uniportal History:經(jīng)肋間單孔胸腔鏡下肺楔形切除單孔VS標(biāo)準(zhǔn)三孔胸腔鏡手術(shù)治療自發(fā)性氣胸：術(shù)后疼痛
3、和感覺(jué)異常比較 Rajwinder Singh Jutley et al. Uniportal vs standard three-port VATS technique for spontaneous pneumothorax: comparison of post-operative pain and residual paraesthesia. Eur J Cardiothorac Surg 2005;28:43-46 Uniportal History: 單孔胸腔鏡下心包開(kāi)窗術(shù) Gaetano Rocco. Uniportal video-assisted thoracoscopic
4、surgery pericardial window. The Journal of Thoracic and Cardiovascular Surgery 2006 131, 921-922DOI: Gaetano Rocco等報(bào)導(dǎo)了自02年至05年4例患者，2例男性淋巴瘤患者和2例女性乳腺癌患者心包侵襲，行單孔胸腔鏡下心包開(kāi)窗術(shù)。 Uniportal History: 單孔胸腔鏡用于縱膈淋巴結(jié)診斷及分期 Gaetano Rocco et al. Uniportal VATS for mediastinal nodal diagnosis and staging .Interact Card
5、ioVasc Thorac Surg 2006;5:430-432 v自2002年1月至2005年10月，13例患者（8例男性，5例女性）v行單孔胸腔鏡下縱膈淋巴結(jié)采樣v 13例均明確病理診斷v住院時(shí)間1天，無(wú)死亡或者并發(fā)癥發(fā)生v安全有效的用于縱膈淋巴結(jié)分期 Diego Gonzalez. thoracoscopic anatomic segmentectomy and right upper lobectomy. Eur J Cardiothorac Surg 2012;42:e169-e171 Uniportal History: 單孔胸腔鏡下解剖型肺段切除+右上肺葉切除v 45歲女性吸煙
6、患者v CT提示右上肺一2cm結(jié)節(jié)和下葉背段一大小約1cmv行單孔胸腔鏡下右上葉切除和背段切除，因?yàn)橄氯~結(jié)節(jié)較深，無(wú)法行楔形切除，所以行背段切除，手術(shù)時(shí)間150minv術(shù)后病理提示上葉腺癌，淋巴結(jié) N0，下葉結(jié)節(jié)提示錯(cuò)構(gòu)瘤 (A) The surgical image of instrumentation during segmentectomy. Diego thoracoscopic anatomic segmentectomy and right upper lobectomy. Eur J Cardiothorac Surg 2012;42:e169-e171 Diego Gonzal
7、ez-Rivas et al. Uniportal video-assisted thoracoscopic bronchial sleeve lobectomy: first report. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 1676-1677DOI: (10.1016/j.jtcvs.2013.02.052) Uniportal History:單孔胸腔鏡下支氣管袖式切除術(shù)：首例報(bào)導(dǎo)v 55歲男性，行誘導(dǎo)化療后v CT提示腫瘤位于右上肺支氣管管口阻塞并肺不張，v患者取左側(cè)臥位，經(jīng)右側(cè)第5肋間一長(zhǎng)約5cm
8、手術(shù)切口，手術(shù)時(shí)間240分鐘v術(shù)后病理提示一大小約1.7cm氣管鱗癌，淋巴結(jié)癌轉(zhuǎn)移（0/25） Diego Gonzalez-Rivas et al.left lower sleevelobectomy by uniportal VATS approach. Interact CardioVasc Thorac Surg 2014;18:237-239 Uniportal History: 單孔胸腔鏡下左下肺袖式切除v 71歲女性v CT提示腫瘤位于左下肺支氣管累計(jì)主支氣管v患者取右側(cè)臥位，左側(cè)第5肋間長(zhǎng)約5cm切口，手術(shù)時(shí)間250minv術(shù)后病理提示2.5cm腫瘤，無(wú)淋巴結(jié)轉(zhuǎn)移（T1bN0M
9、0 ）。 Sequence of sleeve resection and anastomosis. Diego Gonzalez-Rivas et al.left lower sleevelobectomy by uniportal VATS approach. Interact CardioVasc Thorac Surg 2014;18:237-239 Uniportal History:單孔胸腔鏡下雙袖式切除v 65歲男性，有吸煙史v初次發(fā)現(xiàn)CT提示左上肺7.2cm腺癌包繞血管及支氣管v 6次化療后效果差，CT提示腫瘤進(jìn)展至9cmv行單孔胸腔鏡下左上肺雙袖式切除 Diego Gonza
10、lez-Rivas et al Double sleeve uniportal video-assisted thoracoscopic lobectomy for non-small cell lung cancer. Ann Cardiothorac Surg. 2014 Mar;3(2):E2. doi: 10.3978/j.issn.2225-319X.2014.03.13.雙袖式切除.mp4 Uniportal History:非氣管插管單孔胸腔鏡下肺葉切除術(shù)v First case：50歲女性，右上肺4cm腺癌，無(wú)淋巴結(jié)轉(zhuǎn)移，行非氣管插管單孔胸腔鏡下右上肺葉切除v Second c
11、ase：60歲男性，右上肺3cm腫瘤，行右上肺葉切除+系統(tǒng)性淋巴結(jié)清掃v Third case：60歲男性，左上肺4.2cm非小細(xì)胞肺癌侵及胸壁，行左上肺切除+淋巴結(jié)清掃 Diego Gonzalez-Rivas et al. Non-intubated (tubeless) uniportal video-assisted thoracoscopic lobectomy. Ann Cardiothorac Surg. Ann Cardiothorac Surg. 2016 Mar;5(2):151-3. doi: 10.21037/acs.2016.03.02.非氣管插管肺葉切除.mp4 S
12、ubxiphoid Uniportal VATS:胸骨下入路前縱隔腫瘤切除 Kido Tetsuo1. Resection of anterior mediastinal masses through an infrasternal approach. T.Ann Thorac Surg. 1999 Jan;67(1):263-5.v三例女性前縱隔良性腫瘤患者v行經(jīng)胸骨下入路前縱膈腫瘤切除，使用胸骨抬高系統(tǒng)v術(shù)后病理1例胸骨后甲狀腺腫，胸腺及脂肪切除，1例囊性畸胎瘤 Subxiphoid Uniportal VATS: 劍突下單孔左上肺葉切除 Liu CC. Subxiphoid single
13、-incision thoracoscopic left upper lobectomy J Thorac Cardiovasc Surg. 2014 Dec;148(6):3250-1. doi: 10.1016/j.jtcvs.2014.08.033. Epub 2014 Aug 23. Subxiphoid Uniportal VATS:劍突下單孔胸腔鏡下胸腺擴(kuò)大切除術(shù) Lei jiang.subxiphoid uniportal thoracoscopic extended thymectomy. J Thorac Dis. 2015 Sep; 7(9): 16581660. Subxiphoid Uniportal VATS: 劍突下單孔胸腔鏡下右肺中葉+右上肺前段切除 Diego Gonzalez-Rivas, J Thorac Dis. Subxiphoid uniportal video-assisted thoracoscopic middle lobectomy and anterior anatomic segmentectomy (S3)2016 Mar; 8(3): 540543. v 55歲女性患者v CT提示右肺中葉GGO，右上葉前段GGOv行劍突下單孔右肺中葉切除+上葉前段切除v術(shù)后病理右肺中葉原位癌v上葉前段未見(jiàn)惡性病變
單孔胸腔鏡技術(shù)治療進(jìn)展
