胸腔镜肺叶切除术中常见问题的预防和处理

The prevention and management of common intraoperative complications during thoracoscopic lobectomy

目的 总结胸腔镜下肺叶切除术中常见问题的预防和处理方法.方法 2007年6月至2009年12月,通过胸部3个微小切口,共行胸腔镜下肺叶切除术96例.其中右肺上叶切除28例,右肺中叶切除7例,右肺中、下叶切除3例,右肺下叶切除19例,左肺上叶切除12例,左肺下叶切除27例.结果 手术顺利,无围手术期严重并发症及死亡,术中常见问题包括：手术切口及血管出血、胸膜腔广泛粘连、支气管断端漏气.中转开胸4例.手术平均（180±59）min,出血量平均（191±92）ml,2例输血.术后平均胸腔引流（4.6±2.4）天,术后平均住院（8.0±3.2）天.术后病理原发性肺癌85例,硬化性血管瘤3例,支气管扩张3例,结核球2例,隔离肺2例,霉菌球1例.结论 熟练掌握术中常见问题的预防和处理,有助于开展全胸腔镜下肺叶切除术.

Objective To summarize the prevention and management of common intraoperative complications during thoracoscopic lobectomy. Methods During June 2007 to December 2009, 96 patients received thoracoscopic lobectomy through 3 mini-incisons, including right upper lobectomy in 28 cases, right middle lobectomy in 7, right middle and lower lobectomy in 3, right lower lobectomy in 28, left upper lobectomy in 12, and left lower lobectomy in 27. Results All procedure were carried out safely. No severe complications or perioperative death occurred in all cases. The common intraoperative compliations during the surgery included： the bleeding of wounds and vessels, thoracic cavity extensive adhesion, and air leak of bronchus stumps. There were four patients conversed to open thoracotomy. The mean operation time was （ 180 ±59） minutes （range,90 - 360 minutes）, and the mean blood loss was （ 191 ± 92 ） ml （ range,50 - 700 ml ）, including 2 cases blood transfusio（n）. The chest drainage lasted （4.6 ± 2.4 ） days, the average length of stay after operation was （ 8.0 ± 3.2 ） days. Pathological diagnosis included primary lung cancer in 85 cases, sclerosing hemangioma in 3, bronchiectasis in 3, tuberculoma in 2, pulmonary sequestration in 2, and fungus ball in 1. Conclusion It is helpful to master the prevention and management of common intraoperative complications for thoracoscopic lobectomy.