Simultaneous thoracoscopic bilateral pneumonectomy of multiple pulmonary nodules by with 40 cases

Objective To summarize the clinical experience of simultaneous thoracoscopic bilateral pneumonectomy in the treatment of bilateral pulmonary nodules. Methods A retrospective analysis of the clinical data of 40 patients with multiple lung nodules underwent bilateral thoracoscopic pneumonectomy from January 2017 to November 2019. All patients were examined by CT, ECG and pulmonary function before operation to locate double pulmonary nodules and evaluate the pulmonary function reserve. According to the examination, the operation plan was made and sub lobectomy was performed. Operation related indicators(operation time, lesion diameter, intraoperative blood loss, number of lymph nodes) and perioperative related indicators(postoperative drainage time, hospital stay, postoperative pulmonary function index FEV₁), operation mode and intraoperative and postoperative complications; pathological results, clinical efficacy, surgical related complications and The correlation of surgical procedures was analyzed. Results A total of 118 nodules were resected from 40 patients, of which 86(72.88%) were malignant tumors and precancerous lesions, which were distributed in 33 patients. Among them, 4 cases were precancerous lesions, 26 cases were primary lung cancer, 3 cases were other malignant lung tumors. TNM stage of primary lung cancer: 7 cases were stage 0, 14 cases were stage Ⅰ, 4 cases were stage Ⅱ, 1 case was stage Ⅲ, 0 case was stage Ⅳ. Among the primary lung cancer, 5 cases had lymph node metastasis, 4 cases had N1 metastasis, 1 case had N2 metastasis. All patients recovered smoothly. There were no deaths during the hospitalization. The operation time was(139.80±33.12) min, the intraoperative bleeding volume was(150.00±23.63) mL, and the postoperative hospitalization time was(5.42±4.23) d. The postoperative complications included pulmonary infection in 2 cases, arrhythmia in 2 cases, and respiratory failure in 1 case. Surgical related complications mainly occurred in patients with lobectomy(complication rate was 100.0%) and segmental pulmonary segment(complication rate was 50.0%). At the time of discharge, the short-term curative effect was evaluated. Among the patients who underwent wedge resection of lung lobe, there were some invalid cases(2/30, 6.67%). Conclusion Patients with multiple pulmonary nodules screened by preoperative evaluation and undergoing simultaneous bilateral thoracoscopic pneumonectomy are safe and effective. For different pathological types of patients, preoperative comprehensive evaluation is needed to determine the best operation method, to obtain better short-term efficacy and low complications.