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#28 Contest 2019 非气管插管单孔胸腔镜右肺下叶切除+张铎

Zhangduo

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2019国际胸腔镜视频大赛+非气管插管单孔胸腔镜右肺下叶切除+张铎 标题:单孔非气管插管右肺下叶切除 作者:张铎 李伟 李鹤飞 通讯作者:李鹤飞 , E-mail:13831275950@163.com,电话:13831275950. 摘要:患者男性,51岁,间断咳嗽,咳痰伴喘憋1月余,胸部CT:右肺下叶支气管变窄伴阻塞性肺炎。气管镜:右肺下叶外后基底段开口被新生物完全阻塞,活检病理:鳞状细胞癌。行自主呼吸非气管插管单孔胸腔镜右肺下叶切除。 喉罩吸氧,右侧腋前线第5肋间长约3cm切口,医源性气胸后肺萎陷,予2%利多卡因肺表面喷洒,并行胸段迷走神经干阻滞。应用电钩游离下肺韧带及后纵隔胸膜,见下肺静脉后上方肿大淋巴结。电钩打开叶间裂,游离右肺下叶背段及基底段动脉各分支,应用血管钉离断。清扫第9组淋巴结,游离右肺下叶静脉并用血管钉离断。游离右肺下叶支气管并闭合切断,取物袋取出右肺下叶。清扫11组,2R组,4R组淋巴结,探查3A区未见肿大淋巴结,清扫第7组、10组淋巴结,局部放置止血材料。罗哌卡因行肋间神经阻滞,留置胸引管1根。

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