电视胸腔镜辅助小切口肺癌根治术39例报告

Video-assisted Mini-thoracoscopy for Radical Resection of Lung Cancer:Report of 39 Cases

目的探讨电视胸腔镜辅助小切口(video-assisted minithoracotomy,VAMT)肺癌根治术的疗效。方法2002年4月～2008年12月,应用VAMT行根治性肺叶切除术治疗39例肺癌。做1.5cm胸腔镜切口及7～10cm操作切口,采用常规开胸手术器械与胸腔镜成套器械相结合直视操作处理肺血管、支气管行肺叶切除,胸腔镜、直视下行纵隔、肺门区淋巴结清扫。结果39例均获成功。无围手术期死亡,胸腔闭式引流时间4～7d,平均4.5d。术后病理诊断:原发性非小细胞肺癌(NSCLC)37例,转移癌1例,类癌1例;37例NSCLC中术后临床分期:Ⅰa期9例,Ⅰb期13例,Ⅱa期5例,Ⅱb期7例,Ⅲa期2例,Ⅲb期1例。随访35例,其中2～12个月4例,13～24个月15例,25～36个月8例,37～48个月6例,49～60个月2例,因肿瘤复发或转移死亡4例,带瘤生存1例,无瘤生存30例。Ⅰ、Ⅱ期肺癌1年和3年生存率为100%(21/21)、91%(10/11);Ⅲ期肺癌随访3例,3例分别于术后19、11、14个月死于肿瘤复发或转移。结论VAMT肺癌根治术近期疗效良好,将VATS技术与传统开胸技术相结合,既发挥了微创外科的优越性,又达到了传统开胸手术安全、可靠的效果,清扫淋巴结符合肿瘤手术原则,有很好的应用前景。

Objective To evaluate the efficacy of video-assisted mini-thoracoscopy （VAMT） for radical resection of lung cancer. Methods From April 2002 to December 2008, radical resection of lung cancer was performed on 39 patients by VMAT in our hospital. A 1. 5-cm and a 7- to 10-cm incision were made during the operation. Both standard surgical instruments and thoracoscopic set were used to treat the pulmonary vessels, perform lobectomy, and remove tbe lymph nodes in the mediastinum and pulmonary portal. Results The operation was completed in all of the cases. No peri-operative death occurred. The patients received chest drainage for 4 to 7 days after the operation （ mean, 4. 5 days）. Post-operative pathological examination showed primary non-small cell lung cancer （NSCLC） in 37 cases, metastatic cancer in 1, and carcinoid in 1. In the 37 patients with NSCLC, 9 were stage Ⅰ a, 13 were Ⅰb, 5were Ⅱa, 7 were Ⅱb, 2were Ⅲa, and 1 was Ⅲb. Follow-up was available in 35 patients for up to2 to 12 months in 4, 13 to 24 months in 15, 25 to 36 months in 8, 37 to 48 months in 6, and 49 to 60 months in 2 cases. Among the 35 cases, totally 4 patients died of tumor recurrence or metastasis, 1 patient survived with tumor, and the other 30 survived without tumor. The 1- and 3-year survival rate of stage Ⅰ and Ⅱ were 100% （21/21） and 91% （10/11） respectively. All of the 3 stage Ⅲ patients died of recurrence or metastasis in 19, 11, and 14 months respectively after the surgery. Conclusions VAMT is effective for radical resection of lung cancer in a short term. Combination of traditional procedure and VAMT is safe and reliable for the＇disease.