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背景与目的肺孤立结节(solitary pulmonary nodule,SPN)定义为一个圆形的直径小于3 cm的肺实质内的病变,不伴有肺不张和淋巴结病变。本研究旨在探讨达芬奇机器人治疗SPN的临床体会。方法 2011年11月-2014年3月,沈阳军区总医院应用达芬奇机器人治疗SPN 9例,其中男性3例;女性6例;年龄41岁-74岁,平均(51±9.9)岁;患者多数无明显临床症状(健康体检发现7例,咳嗽咳痰2例);病史时间4天-3年(中位数12个月);病变均为周围型肺结节病灶,直径为0.8 cm-2.8 cm,平均(1.4±0.6)cm;术中切取病变送冰冻病理检查,证实为恶性病变者行肺叶切除或楔形切除并常规清除肺门和纵隔淋巴结。手术采用全麻、双腔管气管插管,患者健侧卧位,胸部垫高,双手屈曲抱枕于头前,折刀位。孔位为腋后线第8肋间为进镜孔,肩胛线第8肋间、腋前线与锁中线间第5肋间为器械孔,腋中线第7肋间为辅助口。结果术后病理为良性病变4例(炎性假瘤3例,错构瘤1例),恶性病变5例,均为腺癌。手术包括楔形切除4例,右肺中叶切除+淋巴结清除术2例,左肺上叶切除+淋巴结清除术1例,其余2例肺癌患者因为心肺功能差,病变小于2 cm,行楔形切除+淋巴结清除术。9例均顺利完成机器人手术,所有患者无严重术后并发症,均顺利出院。随访时间为0.1个月-18.5个月(中位数11个月),无复发、转移。结论 SPN病变应该予以积极手术治疗,提高早期肺癌的诊断率和治愈率,达芬奇机器人手术对于SPN的治疗是一种安全、微创的手术方法,在SPN病变的诊治中具有较高的价值。
Background and Objective Solitary pulmonary nodule (SPN) is defined as a lesion within the parenchyma of a lung less than 3 cm in diameter with no associated atelectasis and lymphadenopathy. This study aimed to explore the clinical experience of Da Vinci robot in the treatment of SPN. Methods From November 2011 to March 2014, 9 cases of SPN were treated with Da Vinci robot in Shenyang Military Region General Hospital, including 3 males and 6 females, ranging in age from 41 to 74 years (average, 51 ± 9.9 years). Patients Most of them had no obvious clinical symptoms (7 cases were found in physical examination and 2 cases were cough and expectoration); the history time was 4 days to 3 years (median 12 months); the lesions were all peripheral pulmonary nodules with a diameter of 0.8 cm- 2.8 cm, mean (1.4 ± 0.6) cm; intraoperative lesion sent frozen pathological examination confirmed malignant lesions underwent lobectomy or wedge resection and routine removal of the hilar and mediastinal lymph nodes. Surgical use of anesthesia, dual-lumen tube tracheal intubation, patients with healthy lateral position, chest padded, hands buckling pillow in front of, folding knife bit. Hole position for the eighth intercostal axillary line into the mirror hole, scapular line 8 intercostal space between the anterior axillary line and the intercostal intercostal space for the fifth instrument hole, midrib 7th intercostal space for the auxiliary port. Results Postoperative pathological benign lesions in 4 cases (inflammatory pseudotumor in 3 cases, hamartoma in 1 case), 5 cases of malignant lesions were adenocarcinoma. Surgery included wedge resection in 4 cases, right middle lobe resection + lymph node dissection in 2 cases, left upper lobe resection + lymph node dissection in 1 case, and the remaining 2 cases of lung cancer because of poor cardiopulmonary function, lesions less than 2 cm, wedge resection + lymph node Clear surgery. Nine cases were successfully completed robot surgery, all patients without serious postoperative complications, were successfully discharged. Follow-up time ranged from 0.1 months to 18.5 months (median 11 months), with no recurrence or metastasis. Conclusion SPN lesions should be actively treated surgically to improve the diagnosis and cure rate of early stage lung cancer. Da Vinci robotic surgery is a safe and minimally invasive surgical treatment of SPN and has high value in the diagnosis and treatment of SPN lesions .