电视胸腔镜手术在肺部孤立性结节诊治中的应用

Video-assistant thoracoscopy for the diagnosis and treatment of solitary pulmonary nodule:report of 20 cases

目的总结利用电视胸腔镜手术(VATS)对孤立性肺结节病人进行诊治的体会。方法对诊断不明的孤立性肺结节样病变20例,肿物部位探寻明确后,行电视胸腔镜肺楔形切除术,术中送冰冻快速病理检查。结果20例病人中16例为肺癌,其中腺癌12例,细支气管肺泡癌1例,鳞癌2例,转移性肿瘤1例;良性病变中包括炎性假瘤2例,结核球1例,炎性肿块1例。13例经VATS单纯肺楔形切除,7例肺癌行辅助小切口肺叶切除加淋巴结清扫。全组病人无围手术期死亡,未出现严重的手术并发症。结论VATS对孤立性肺结节的诊治提供了一个创伤小,对患者生理干扰小,确诊率高,安全可靠,易被患者所接受的新手段。

Objective To evaluate the significance of video- assisted thoracoscopic surgery （VATS） in the diagnosis and treatment of solitary pulmonary nodule. Methods After thoracoscopic exploration, 20 cases with solitary pulmonary nodule underwent wedge resection followed by frozen section diagnosis. Results Final diagnosis were obtained in all cases, including 16 lung carcinoma which included 12 adenocarcinoma, one bronehioalveolar carcinoma, one squamous cell carcinoma and one metastasis carcinoma, and benign lesions included two inflammatory pseudotumor, one tuberuloma and one inflammatory mass. Singe wedge resections under thoracoscopy were done in 13 cases, the others accompanied by small incision lobectomy plus mediastinal lymph nodes dissections. There were no perioperative mortality or severe complications in all cases. Conclusion VATS is a new approach for the diagnosis and treatment of solitary pulmonary nodule, with less invasion but more safety and efficacy.