电视胸腔镜在肺部结节的诊断和治疗中的应用

Application of video thoracoscope in mini-tumor of lung

目的探讨电视胸腔镜（VATS）在肺部结节诊断和治疗中的应用价值。方法2000年5月至2005年8月利用VATS诊断治疗肺部结节病人112例，116次（双侧4次）VATS手术（包括小切口辅助31例和中转开胸2例）切除瘤体123个，其中男性63例，女性49例，年龄13-80岁，平均51岁；病变在右肺57例，左肺51例，双肺4例；VATS完成手术81例，小切口辅助下完成手术31例，中转开胸2例。手术方式：以VATS行肺楔形切除或肿物剥出并术中快速病理检查，若回报为恶性病变则加小切口行肺叶切除纵隔淋巴结清扫术，若报为良性则结束手术。结果肺楔形切除68例72次（其中4例双肺病变行双侧VATS），肺叶切除23例，肿物切除21例。本组无手术死亡病例，平均术后住院4.3天。术后病理：肺良性病变61例（包括结核球13例，炎性假瘤11例，错构瘤21例，肺囊肿1例，硬化性血管瘤5例，曲霉菌球4例，神经鞘瘤1例，慢性肉芽肿4例，结节病1例）。肺恶性病变5l例（包括腺癌33侧，鳞癌5例，支气管肺泡癌6例，小细胞肺癌1例）。肺转移瘤5例。术前诊断恶性肿瘤术中快速病理证实为良性病变27例，术前诊断恶性术中病理证实为恶性3例。结论在肺部肿瘤手术中VATS结合术中快速病理可起到诊断和治疗一体化的作用，并且具有安全、微创、疼痛轻、恢复快的效果，拥有广阔的应用前景。

Objective To provide evidence of value appling video thoracoscope （VATS） in mini-tumor of lung. Methods 112 patients （63 males and 49 famale） of an average age of 51 with minitumor of lung were healed by VATS, 116 VATS operations. 81 patients were used only by VATS, 31 by VATS and additional small cut in whom goiter in right lung is 57, and 51 in left lung, and 4 in both lungs. Modus operandi： we operated patient＇s lung with wedge excision or shelling goiter by VATS and the mini-tumor was sended for tacho-pathology. Results Patients＇wedge excision in lung were 68 or 72 times, lobes of lung excision were 23, only wedge excision in lung were 21. None of patients died. Average days in hospital were 4. 3. Pathology after operation ： the number of benign tumor in patients were 61.（tuberculoma of 13, inflammatory pseudotumnr of 11, hamartoma of 21, lung cyst of 1, angeioma ofS, aspergilloma of 4, myoschwan- noma of 1, chronic granuloma of 4, and La Verruga disease of 1） malignant tumor in patients were of 51. （ adencarcinoma of 33, SqCa of 5, alveolar cell carcinoma of 6, SCC of 1）. The number of tumor aversed in lung were 5, 27 patients diagnosed malignant tumor in preop- erative were confirmed benign while 3 patients diagnosed malignant tumor in preoperative were confirmed malig. Conclusion VATS combinating tacho-pathalogy is able to integrate diacrisis and with advantages being safe, with smaller cut, little pain, faster recovery.