保留胸肌腋下开胸术在肺癌完全性切除中的应用

Clinical application of muscle-sparing Axillary Thoracotomy in lung cancer completing resection

目的探讨保留胸肌腋下开胸术在肺癌完全性切除中应用的可行性。方法对471例非小细胞肺癌患者实施保留胸肌腋下剖胸切口的完全性切除术,保留背阔肌和前锯肌,经第4或第5肋间完成。记录切口长度、出血量、开胸时间、淋巴结清扫情况,观察术后疼痛情况、术侧上肢活动范围、肺功能等情况。结果无1例手术死亡及发生严重并发症。保留胸肌腋下剖胸切口短、出血少、开关胸时间短,肺门、纵隔淋巴结清扫数相似,术后疼痛轻、术侧上肢活动范围及肺功能恢复快。结论保留胸肌腋下剖胸切口应用于肺癌完全性切除可获得满意的手术效果。

Objective To asses the clinical application of muscle - sparing axillary thoracotomy （ MS - AT） in lung cancer completing resection. Methods 471 patients with non - small cell lung cancer underwent the lung cancer complicating resection through MS - AT. The access incision was performed in the 4th or 5th intercostal space. Musculi latissimusdorsi and musculi serratus anterior were sparing in the surgical procedures. The incision length, bleeding, open and close time, number of dissected lmphy node, the degree of postoperative pain, the movement of operative upper limb and lung function were inverstingated. Results There were no operative mortality and severe complications. The incision length in MS - AT was shorter, amount of bleeding was less, open and close time was briefer, the degree of postoperative pain was slighter than postlateral thoracotomy. The movement of operative upper limb and lung function after operation recovered faster than standard postlateral thoracotomy and the number of dissected hnphy node in hilar and mediastinum at MS - AT was approximate. Conclusion MS - AT can be achieved with excellent clinical outcome in lung cancer completing resection.