胸腔镜肺叶切除术治疗肺周围型肺癌

Management of peripheral lung cancer with VATS lobectomy

目的讨论胸腔镜肺叶切除术治疗肺周围型肺癌的临床意义。方法2004～2006年共进行胸腔镜肺叶切除术治疗肺周围型肺癌172例。其中女性78例(45.3%),男性94例(54.7%),患者平均年龄59.2岁。患者术后病理诊断:肺部转移性肿瘤4例,肺癌168例。其中腺癌106例,在原发性肺癌中占63.1%。解剖意义上彻底的肺门切除和淋巴结活检或清扫均通过观察监视器屏幕完成,切口长约5cm,不需撑开肋骨。结果2例(1.2%)死亡(无术中死亡及出血死亡患者),6例(3.5%)患者术中转为开胸手术,158例(91.9%)术后没有出现并发症。172例患者中有8例(4.6%)术中输血,1例患者术后输血。中位住院时间7d,平均住院时间8.72d,42例(24.4%)患者于术后第5天出院。其中2005～2006年,247例肺叶切除中108例(43.7%)通过胸腔镜完成。结论在胸腔镜下可完成解剖意义上彻底的肺叶切除,能规范地完成肺周围型肺癌根治术,治疗肺周围型肺癌并发症率和死亡率较低。

[Objective] To study the clinical meaning of video assisted thoracoscope surgery （VATS） in peripheral lung surgery. [Method] From 2004 to 2006, we performed 172 patiens of peripheral lung cancer by VATS lobeetomies in 78 （45.3%） women and 94 men （54.7%）, mean age=59.2 years. Diagnosis was as follows： lung metastatic tumor （4）, and lung cancer（168）. 106 cases （63.1% ）of the primary lung cancers were adenocarcinomas. With visualization on a monitor, anatomichilar dissection and lymph nodes ampling or dissection were performed, pri- marily through a 5 cm incision without spreading the ribs. [ Results ] There were 2 deaths （1.2%） and none of them were intra-operative or due to bleeding. Conversion to a thoracotomy occurred in 6 patients （3.5%）. Length of stay was median 7 days, mean 8.72 days. 42 patients were discharged on POD 5 （24.4%）. From 2005 to 2006,43.7% of 247 lobectomies were performed with VATS. [Conclusions] VATS lobectomy with anatomic dissection can be performed with low morbidity and mortality. The risk of intraoperative bleeding or conversion to a thoracotomy seems minimal.