胸腔镜辅助小切口肺血管/支气管成形术治疗肺肿瘤

Bronchial sleeve resection and reconstruction of pulmonary artery by video-assisted thoracic small incision surgery for lung cancer

背景与目的 微创胸外科作为一门新兴学科近年得到广泛应用,其在肺癌完全性切除术中的应用已有定论.本研究的目的是探讨胸腔镜辅助小切口施行肺支气管和肺动脉袖式切除术治疗肺肿瘤的可行性及效果.方法 回顾性分析了从1995年1月至2005年12月因病变涉及肺叶开口或肺动脉而采用胸腔镜辅助小切口肺支气管和肺动脉袖式切除术的109例患者资料.结果 109例患者全部在胸腔镜辅助小切口下顺利完成手术.上肺袖式切除采用1 cm切口2个,辅助切口3～15 cm 1个;下肺袖式切除采用1 cm切口1个,辅助切口3～15 cm 1个;109例辅助切口的平均长度为10 cm.通过胸腔镜小切口,完成标准支气管袖状切除术和肺动脉成形术;手术时间125～180 min,平均150 min;出血量210～450 mL,平均320 mL.术后均未发现吻合口狭窄、吻合口瘘及切缘癌细胞存留,无围手术期死亡.肺动脉成形病例保留的肺叶也没有发现肺再灌注损伤或明显肺水肿征象.80.7%(88/109)的患者术后不需要输血,94.5%(103/109)的患者术后未出现肩关节运动障碍.术后住院时间7～15天,平均9天.结论 胸腔镜辅助小切口具有与标准切口相同的适应证,不仅可以完成同样的工作程序和范围,而且还具有实时分期、减少单纯探查、提高手术切除率、创伤小、恢复快、出血输血少、开关胸时间短的优点.

Background and objective The mini-invasive surgery is now performed widely and these operations have been used in complete resection of lung cancer. The aim of this study is to summarize the results and to explore practicability of bronchial sleeve resection and reconstruction of pulmonary artery by video-assisted thoracic small incision surgery for lung neoplasms. Methods A total of 109 patients were retrospectively reviewed, who underwent sleeve lobectomy and bronchoplasty by video-assisted thoracic small incision surgery for lung neoplasms from January 1995 to December 2005. Results Operations were performed successfully for all the patients. The small incisions’ length ranged from 3 to 15 cm and the mean length was 10 cm. The surgical time was 125-180 min and the mean was 150 min; blood loss was 210-450 mL and the mean was 320 mL. There was no operative mortality, occurrence of anastomosis stenosis and fistula. Follow-up results showed that there was no sign of re-perfusion hurt and no edema in remaining lobes. There was no blood transfusion in 80.7% of cases (88/109), no shoulder hurt in 94.5% of cases (103/109). The stay in hospital was 7-15 days, and the average was 9 days. Conclusion The bronchial sleeve resection and reconstruction of pulmonary artery by video-assisted thoracic small incision surgery for lung cancer could finish the same work as traditional thoracic lateral incision, with less trauma, less bleeding and blood transfusion, less time in opening and closing thorax.