|
【摘要】 目的 探讨胸腔镜全镜下肺叶切除的安全性和可靠性，评价其适应症。 方法 2006 年 9 月至 2008 年 6 月共施行胸腔镜全镜下肺叶切除 100 例，男性 46 例，女性 54 例，年龄 18~82 岁，平均 60.1 + 12.5 岁 。手术通过胸部三个微小切口全程非直视下完成，均为解剖性肺叶切除，恶性肿瘤同时施行淋巴结清扫。 结果 原发性肺癌 81 例，肺内淋巴瘤 1 例，透明细胞癌肺转移 1 例，良性疾病 17 例。施行右肺上叶切除 25 例，右肺中叶切除 14 例，右肺下叶切除 22 例，左肺上叶切除 18 例，左肺下叶切除 21 例。中转开胸 3 例，术后并发症 5 例，无严重并发症及围手术期死亡。平均手术时间 186.4+52.9 min （ 60 ～ 300min ），平均出血 233.9 + 275.9 ml （ 50 ～ 750ml ），输血 1 例，平均胸引时间 7.1 + 3.0 天， 术后平均住院 9.5 + 3.2 天。 随访原发肺癌中 2 例分别于术后 15 个月和 3 个月发生远处转移， 其余患者无复发、转移。 结论 胸腔镜肺叶切除是一种安全有效微创的术式，适于经选择的肺癌和需要肺叶切除的良性疾病。
【关键词】胸腔镜，肺叶切除，适应症
Primary experience of 100 consequative completely thoracoscopic lobectomy in a single center
LI Jianfeng, YANG Fan, LI Yun, WANG Jun, LIU Jun, JIANG Guanchao, ZHAO Hui, LIU Yanguo, ZHOU Zuli, BU Liang
Department of Thoracic Surgery , Peking University, People's hospital, 100044
【 Abstract 】 Objective The aim of this study was to evaluate the safety and effecacy of completely thoracoscopic lobectomy procedures. The indications of this procedure were clarified at mean time. Methods Between Sep 2006 and Jun 2008, 100 consequative patients （ 46 men ， 54 women, median age 60.1 + 12. 5 years ， range from 18 to 82 years) underwent completely thoracoscopic lobectomy . The lobectomy was completed through three tiny incisions in the intercostal space. Anatomic lobectomies were carried out in all cases and systemic lymphonode dissection was performed in malignancies. Results All procedures were successfully completed except for 3 conversions to thoracotomy. Postoperative diagnosis were primary lung cancer (n=81), lymphoma (n=1), metastasis of clear cell carcinoma from kidney (n=1), and, benign lesions (n=17). This group consisted of lobectomies of right upper lobe (n=25), right middle lobe (n=14), right lower lobe (n=22), left upper lobe (n=18), and left lower lobe (n=21). Five patients had mild complications. No operative mortality or serious complications occured in this group. The average operation time was 186.4+52.9 min （ range from 60 to 300 minutes ） . The average blood loss was 233.9 + 275.9 ml （ range from 50 to 750ml ） and only one case needed blood transfusion. Mean chest drainage time was 7.1 + 3.0 days. Mean postoperative hospital stay was 9.5 + 3.2 days. Metastasis occurred in two patients with primary lung cancer 15 and 3 months after operation. Conclusion The completely thoracoscopic lobectomy is a safe and feasible surgical procedure with minimal invasiveness. The advocated indications include selected lung cancer and benign pulmonary lesions which need lobectomy.
【 Key words 】 video-assisted thoracoscopic surgery, lobectomy, indication
胸腔镜肺叶切除始于 1993 年 Kirby [1] 的报道，英文名称是 Video-assisted thoracic surgery (VATS) lobectomy 。由于创伤小、疼痛轻等突出优势，该方法迅速在欧美日韩以及我国的香港和台湾地区得到了较快发展 [2,3] 。 1995 年王俊 [4] 报道了我国大陆第一组胸腔镜肺叶切除手术。然而，由于我国地区经济的差异，一次性腔镜手术器械完全依赖进口，费用高昂，所以全镜下肺叶切除技术一度停滞不前，各种辅以小切口的改良方法应运而生。小切口手术与胸腔镜手术最大的区别在于需要开胸器撑开肋间隙，切口疼痛问题并没有得到根本改善。过多地依赖小切口直视操作，使胸腔镜的技术优势几乎丧失，甚至沦为“高级光源”。此外，国内多数学者对该技术的安全性和治疗肺癌的可靠性尚普遍存在怀疑，迫切需要一组国内的数据进行验证。我们自 2006 年 9 月开始对包括早期肺癌在内的胸外科疾病常规开展该项手术，至 2008 年 6 月同一手术小组已连续完成了 100 例。作者拟对该项技术的安全性和可靠性进行分析。
资料与方法
1.一般资料
2006 年 9 月至 2008 年 6 月共施行胸腔镜全镜下肺叶切除 100 例，男性 46 例，女性 54 例，年龄 18~82 岁，平均 60.1 + 12.5 岁 。病变最大径平均 2.5 ± 1.4 c m （ 0.6 ～ 6cm ）。
>>>下一页
|
