胸腔镜术治疗肺转移瘤的可行性分析

Feasibility of Thoracoscopic Pulmonary Metastasectomy

背景与目的:随着内镜外科和影像学技术的进步,胸腔镜术治疗肺转移瘤的应用越来越广泛,本研究拟对胸腔镜术治疗肺转移瘤的可行性进行探讨。方法:对经胸腔镜术治疗的17例肺转移瘤患者的资料进行回顾性分析。结果:本组17例肺转移瘤均为原发肿瘤治疗后随访时发现,均位于肺外周,且排除肺外转移。其中孤立性转移瘤10例,单侧多发转移瘤4例,双侧多发转移瘤3例,全部行胸腔镜下肺楔形切除术。无手术死亡,无术后严重并发症,无切口肿瘤种植。术后局部复发5例,4例为多发肺转移患者,另1例软组织肉瘤孤立转移患者再次行胸腔镜术切除复发性肺转移瘤。1、3、5年生存率分别为77.3%、53.1%和34.8%。结论:对外周肺野、直径≤3cm、特别是孤立性肺转移瘤采用胸腔镜术治疗完全可行、有效,双肺转移瘤亦可一期切除。

BACKGROUND ＆ OBJECTIVE： endoscopic surgery and the advances of With the developments in radiological techniques, thoracoscopic pulmonary metastasectomy has been used more and more widely. This study was to evaluate the feasibility of thoracoscopic resection of pulmonary metastases. METHODS： The clinical data of 17 patients who underwent thoracoscopic pulmonary metastasectomy were retrospectively analyzed. RESULTS： All pulmonary metastases in the 17 patients were peripherally located and encountered during follow-up after treatment of primary disease. Metastases at other sites were excluded. Among the 17 cases of metastases, 10 were solitary metastasis, 4 were unilateral multiple metastases, 3 were bilateral metastases. All patients underwent thoracoscopic wedge resection. No major complications, operative mortality, and port site metastasis presented. Postoperative Iocoregional relapse occurred in 5 patients, in which 4 patients had multiple metastases, the rest 1 patient with soft tissue sarcoma underwent a second thoracoscopic resection of recurrent pulmonary lesion. The 1-, 3-, and 5-year survival rates were 77.3%, 53.1%, and 34.8%, respectively. CONCLUSIONS： Thoracoscopic resection is feasible and effective for patients with a solitary pulmonary metastasis, especially when the lesion is smaller than 3 cm and peripherally located. Bilateral pulmonary metastases may also be resected by primary thoracoscopic operation.