电视胸腔镜辅助小切口肺叶切除35例临床分析

Video-assisted thoracoscopic mini-invasive lobectomy: A clinical analysis of 35 cases

目的探讨胸腔镜辅助小切口肺叶切除在早期肺癌及肺良性病变治疗中的应用价值。方法回顾分析我院2002年2月～2006年6月行胸腔镜辅助小切口肺叶切除35例的临床资料。其中周围型肺癌(T1N0～1M0)31例,支气管扩张症3例,右肺中叶不张并脓肿1例。解剖性肺叶切除30例,非解剖性肺叶切除5例。结果本组无中转开胸,手术时间85～210min,(115±35)min。术中出血150～450ml,(210±55)ml。2例术后并发急性呼吸衰竭,使用呼吸机辅助机械通气分别治疗3、5d后顺利脱机;1例术后急性心肌梗死,经早期溶栓治疗痊愈。其余32例无术后并发症。全组拔除胸腔闭式引流管时间2～10d,平均5.4d。3例肺良性病变,随访41、33、13个月,无明显远期并发症;25例肺癌平均随访时间15.2月(3～53个月),其中随访3～12个月6例、12～24个月9例、24～36个月7例、36～53个月3例,因肺癌复发或转移死亡4例(16%),肿瘤复发带瘤生存2例(8%),无瘤生存19例(76%)。结论胸腔镜肺叶切除对周围型肺癌(T1N0～1M0)及肺部局限性良性病变是一种完全可行并且安全的手术方法。

Objective To assess the value of video-assisted thoracoscopic mini-invasive lobectomy in the treatment of pulmonary benign lesions or malignancies. Methods A retrospectively analysis on clinical data of 35 cases of video-assisted thoracoscopic mini-invasive lobectomy, which were performed from February 2002 to June 2006, was made. The pathological diagnosis included 31 cases of peripheral lung cancer （T1N0-lM0 ）, 3 cases of bronchiectasis, and 1 case of atelectasis combined with pulmonary abscess. The procedures included 30 cases of anatomical lobectomy and 5 cases of non-anatomical lobectomy. Results No conversion to open surgery was required. The operation time was 85 -210 min （115 ± 35 min） and the intraoperative blood loss was 150-450 ml （210 ±55 ml）. Postoperatively, acute respiratory failure was encountered in 2 cases, and mechanical ventilation was given for 3 and 5 days, respectively. Acute myocardial infarction occurred in 1 case, which was cured by early-stage thrombolysis. No postoperative complications were seen in the remaining 32 cases. The closed chest drainage was maintained for 2 - 10 days （ mean, 5.4 days）. In 3 cases of pulmonary benign lesions, follow-up checkups for 41, 33, and 13 months, respectively, found no long-term complications. In 25 cases of lung cancer, follow-up observations were made for 3 -53 months （mean, 15.2 months） , including 3 - 12 month in 6 cases, 12 -24 months in 9 cases, 24 - 36 months in 7 cases, and 36 - 53 months in 3 cases. There were 4 cases of death due to cancer recurrence or metastasis （ 16% ）, 2 cases of with-tumor survival （8%）, and 19 cases of disease-free survival （76%）, respectively. Conclusions Video-assisted thoracoscopic mini-invasive lobectomy is a feasible and safe procedure for peripheral lung cancer and benign lung diseases.