微创技术在肺癌支气管/肺动脉成型术中的应用探讨

Lobectomy with Bronchoplasty and Reconstruction of Pulmonary Artery by Minitrauma-technique for Lung Cancer

背景与目的探讨小切口微创技术和常规后外侧切口手术在支气管、肺动脉成形术中的应用效果及可行性。方法患者来自山东省立医院胸外科,自2005年7月-2009年6月因肿瘤侵及支气管口和/或肺动脉,需要行支气管和/或肺动脉成形术,经腋下第3、4或5肋间弧形小切口完成的患者61例,其中3例因肿瘤同时累及部分上腔静脉,又行上腔静脉成型;经传统后外侧切口行支气管和/或肺动脉成形术46例。其中腋下小切口应用头灯照明者43例,应用胸腔镜辅助者18例。辅助胸腔镜者行上叶切除时于第2肋、第7肋间增加小切口术中用于照明及操作,术后为引流孔;下叶切除时仅增加第7肋间切口。术后3个月门诊随访疼痛情况,采用视觉模拟评分法(VAS)。结果两组患者均顺利完成手术,无围术期死亡,术后无支气管狭窄、支气管胸膜漏等严重并发症。小切口组切口长度为8cm-15cm;常规后外侧切口长度25cm-35cm,两者有统计学差异(Z=-8.860,P<0.001)。清扫纵隔淋巴结数两组相近(Z=-0.941,P=0.346)。小切口组患者术后第1天术侧上肢即可高举过头,后外侧切口组则在3d-30d做到。术后3个月复查,小切口组随访57(57/61)例,后外侧切口组41(41/46)例。小切口组49例诉刀口偶有疼痛,VAS评分1分-5分,无需药物治疗;后外侧切口组评分1分-9分,慢性疼痛方面后者较前者明显(Z=-2.812,P=0.005)。结论腋下小切口及标准后外侧切口均可施行支气管、肺动脉成型术,腋下小切口未增加手术风险及并发症,而且可彻底清扫纵隔淋巴结;此外,小切口手术具有创伤小、疼痛轻的优点。

Background and objective To research the effect and practicalbility of lobectomy with bronchoplasty and reconstruction of pulmonary artery by minitrauma-technique for lung cancer.Methods We retrospectibely reviewed our experience on 61 cases being lobectomy with bronchoplasty and bronchoplasty with or without video assisted thoracic small incision surgery for lung cancer from July 2005 to June 2009 from Shandong Provincal Hospital and 46 cases simultaneously by routine posterolateral incision.All patients whose bronchus and/or pulmonary artery were involved underwent the operation and experienced the bronchial sleeve/wedge resection or reconstruction of the pulmonary artery.Results All patients were done operation successfully and there were no operative mortality and no occurrence of anastomosis stenosis as well as fistula.The small incisions＇ length was from 8 cm-15 cm while the routine posterolateral incision＇s length was 25 cm-35 cm.The patients done the operation of small incision had less postoperative shoulder joint dysfunction and had better quality of life compaired to the patients done the routine posterolateral incision.Conclusion Lobectomy with bronchoplasty and reconstruction of pulmonary artery by minitrauma-technique for lung cancer could finished the same work with the traditional thoracic lateral incision and had less trauma,less pain,less recovery time.