单孔胸腔镜技术治疗进展.ppt

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单孔胸腔镜技术治疗进展,河南大学第一附属医院,胸心血管外科 杨忠信,zhongxin1985,Wechat:18737821895,经胸单孔胸腔镜治疗进展,经剑突下单孔胸腔镜治疗进展,病例分享,Uniportal History:,单孔内镜下手汗症治疗,自,1995,年,1,月,100,例患者（,46,例女性、,54,例男性）接收双侧单孔内镜下手汗症治疗。,双侧同期在,30,分钟内完成,96%,患者顺利康复并第,2,天出院,手术时间、住院时间缩短、疗效均优于开放手术,Vanaclocha.Uniportal endoscopic superior thoracic sympathectomy.Neurosurgery.2000 Apr;46(4):924-8.,Uniportal History:,经肋间单孔胸腔镜下肺楔形切除,Gaetano Rocco.Uniportal VATS wedge pulmonary resections.The Annals of Thoracic Surgery.2004 Feb;77(2):726-8.,自,2000,年,15,例患者，其中,10,例不明原因肺间质病变，,5,例自发性气胸患者,行单孔胸腔镜下肺楔形切除,肺间质病变患者均明确诊断，气胸患者无复发,单孔胸腔镜手术行肺楔形切除是安全有效的,Uniportal History:,经肋间单孔胸腔镜下肺楔形切除单孔,VS,标准三孔胸腔镜手术治疗自发性气胸：术后疼痛和感觉异常比较,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:,单孔胸腔镜下心包开窗术,Gaetano Rocco.Uniportal video-assisted thoracoscopic surgery pericardial window.The Journal of Thoracic and Cardiovascular Surgery2006 131,921-922DOI:,Gaetano Rocco,等报导了自,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袭，行单孔胸腔镜下心包开窗术。,Uniportal History:,单孔胸腔镜用于纵膈淋巴结诊断及分期,Gaetano Rocco et al.,Uniportal VATS for mediastinal nodal diagnosis and staging.,Interact CardioVasc Thorac Surg 2006;5:430-432,自,2002,年,1,月至,2005,年,10,月，,13,例患者（,8,例男性，,5,例女性）,行单孔胸腔镜下纵膈淋巴结采样,13,例均明确病理诊断,住院时间,1,天，无死亡或者并发症发生,安全有效的用于纵膈淋巴结分期,Diego Gonzalez.,thoracoscopic anatomic segmentectomy and right upper lobectomy.,Eur J Cardiothorac Surg 2012;42:e169-e171,Uniportal History:,单孔胸腔镜下解剖型肺段切除,+,右上肺叶切除,45,岁女性吸烟患者,CT,提示右上肺一,2cm,结节,和,下叶背段一大小约,1cm,行单孔胸腔镜下右上叶切除和背段切除，因为下叶结节较深，无法行楔形切除，所以行背段切除，手术时间,150min,术后病理提示上叶腺癌，淋巴结,N0,，下叶结节提示错构瘤,(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 Gonzalez-Rivas et al.Uniportal video-assisted thoracoscopic bronchial sleeve lobectomy:first report.,The Journal of Thoracic and Cardiovascular Surgery2013 145,1676-1677DOI:(10.1016/j.jtcvs.2013.02.052),Uniportal History:,单孔胸腔镜下支气管袖式切除术：首例报导,55,岁,男,性,，行诱导化疗后,CT,提示,肿瘤位于右上肺支气管管口阻塞并肺不张，,患者取左侧卧位，经右侧第,5,肋间一长约,5cm,手术切口，手术时间,240,分钟,术后病理提示一大小约,1.7cm,气管鳞癌，淋巴结癌转移（,0/25,）,Diego Gonzalez-Rivas et al,.left lower sleevelobectomy by uniportal VATS approach,.,Interact CardioVasc Thorac Surg 2014;18:237-239,Uniportal History:,单孔胸腔镜下左下肺袖式切除,71,岁,女,性,CT,提示肿瘤位于左下肺支气管累计主支气管,患者取右侧卧位，左侧第,5,肋间长约,5cm,切口，手术时间,250min,术后病理提示,2.5cm,肿瘤，无淋巴结转移（,T1bN0M0,）。,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:,单孔胸腔镜下双袖式切除,65,岁男性，有吸烟史,初次发现,CT,提示左上肺,7.2cm,腺癌包绕血管及支气管,6,次化疗后效果差，,CT,提示肿瘤进展至,9cm,行单孔胸腔镜下左上肺双袖式切除,Diego Gonzalez-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.,双袖式切除,.mp4,Uniportal History:,非气管插管单孔胸腔镜下肺叶切除术,First case,：,50,岁女性，右上肺,4cm,腺癌，无淋巴结转移，行非气管插管单孔胸腔镜下右上肺叶切除,Second case,：,60,岁男性，右上肺,3cm,肿瘤，行右上肺叶切除,+,系统性淋巴结清扫,Third case,：,60,岁男性，左上肺,4.2cm,非小细胞肺癌侵及胸壁，行左上肺切除,+,淋巴结清扫,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.,非气管插管肺叶切除,.mp4,Subxiphoid Uniportal VATS:,胸骨下入路前纵隔肿瘤切除,Kido T,etsuo,1.,Resection of anterior mediastinal masses through an infrasternal approach.,T,.,Ann Thorac Surg.,1999 Jan;67(1):263-5.,三例女性前纵隔良性肿瘤患者,行经胸骨下入路前纵膈肿瘤切除，使用胸骨抬高系统,术后病理,1,例胸骨后甲状腺肿，胸腺及脂肪切除，,1,例囊性畸胎瘤,Subxiphoid Uniportal VATS:,剑突下单孔左上肺叶切除,Liu CC,.Subxiphoidsingle-incision thoracoscopic left upperlobectomy,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:,剑突下单孔胸腔镜下胸腺扩大切除术,L,ei jiang.subxiphoid uniportal thoracoscopic extended thymectomy.,J Thorac Dis,.2015 Sep;7(9):16581660.,Subxiphoid Uniportal VATS:,剑突下单孔胸腔镜下右肺中叶,+,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.,55,岁女性患者,CT,提示右肺中叶,GGO,，右上叶前段,GGO,行剑突下单孔右肺中叶切除,+,上叶前段切除,术后病理右肺中叶原位癌,上叶前段未见恶性病变,