电视胸腔镜辅助小切口诊疗肺部小结节

Diagnosis and Treatment of Small Pulmonary Nodules via Video-assisted Thoracic Small Incision

目的探讨电视胸腔镜辅助小切口诊治肺部小结节的价值。方法2007年2月～2008年2月,对53例40岁以上肺孤立性小结节(直径≤3cm)应用电视胸腔镜辅助小切口技术行肺小结节病灶切除,术中快速冰冻切片,对恶性病变按恶性肿瘤手术原则进一步手术,良性病变则结束手术。结果诊断恶性病变39例,其中34例原发性肺癌行胸腔镜辅助小切口肺癌根治术,2例双侧肺癌和3例肺转移癌行胸腔镜辅助小切口病灶切除术;14例术中病理诊断为肺良性病变,仅行病灶切除术。34例原发性肺癌中1例失访,余33例随访2～12个月,平均7个月,31例无瘤生存,2例术后6个月内复发,行肺叶切除术。2例双侧肺癌和3例肺转移癌均死亡,生存时间2～6个月,平均4个月。14例良性病变随访3～12个月,平均7.5月,无复发。结论电视胸腔镜辅助小切口诊治肺部小结节,创伤小,诊断准确,具有很大优势。

Objective To investigate the efficacy of video-assisted thoracic small incision in diagnosis and treatment of small pulmonary nodules. Methods From February 2007 to February 2008, 53 patients （ aged over 40 years） with small solitary pulmonary nodule （ ≤3 cm in diameter） were treated by video-assisted thoracoscopy via a small incision. The nodules were removed during the opbration, and then based on the results of quick pathological examination, malignant cases received further surgeries. Results Totally 39 patients were diagnosed with malignant disease, 34 of them received small-incision radical lobectomy for primary lung cancer, small-incision resection of the lesions were performed on 5 patients who had bilateral （2 cases） or metastatic lung cancer （3 cases）. Benign lesions were confirmed in 14 patients during the operation, and were removed by local resection. All of the patients with primary lung cancer, except one, achieved an mean of 7 months follow-up （ranged 2 to 12 months）, 31 of the patients survived without tumor during the period ; 2 patients showed recurrent cancer in 6 months after the operation, and thus received lobectomy. The 2 patients who had bilateral lung cancer and the 3 cases of metastatic lung cancer died in 2 to 6 months （ mean, 4 months） after the surgery. The 14 benign cases were followed up for 3 to 12 months （mean, 7. 5 months） , none of them had recurrence. Conclusion Video-assisted thoracic small incision is effective in the diagnose and treatment of small pulmonary nodules.