全电视胸腔镜下肺叶切除术

Clinical experience of completely video-assisted thoracic surgery lobectomy

目的总结探讨全电视胸腔镜肺叶切除的安全手术方法。方法在自2008年7月至2010年3月以来共完成全电胸腔镜下肺叶切除57例,男34例,女23例,年龄45～78岁。临床诊断支气管扩张症3例,肺曲菌球病2例,肺硬化性血管瘤2例,慢性肺部炎症1例,肺癌49例。腋中线第7或第8肋间作镜孔(1.5～2cm),肩胛下角线第7或第8肋间作操作孔(1.5～2cm),腋前线与锁骨中线间第4肋间(上中叶切除)或第5肋间(下叶切除)作一长约4～6cm辅助切口,便于游离肺门血管和取出被切肺叶。术中应用血管切割缝合器处理血管、支气管。结果切除左肺上叶12例,左肺下叶13例,右肺上叶11例,右肺中叶5例,右肺下叶16例。术后平均胸管引流量50～150ml/d。平均住院时间10.5d。全组无死亡病例。结论全电视胸腔镜肺叶切除具有出血少、疼痛小、住院时间短和病程恢复快等优点。胸外科医师经过相关训练完全能掌握这项微创技术进行安全手术。

Objective To observe and evaluate the results of Completely VATS lobectomy. Methods Between July 2008 and March 2010, we performed 57 VATS lobectomies in 34 men and 23 women, with age among 45 and 78 years. Diagnoses were as follows： 3 bronchiectasis,2 Fungus ball disease, 2 Sclerosing hemangioma,1 abcess and 49 lung cancers. Two 1.5-2.0 cm incisions were made. One of the incisions is placed at the auscultatory triangle area, another was placed at the seventh or eighth intercostal spaces in the midaxillary line for the videoscope. An additional 4-6 cm utility incision which was for the hilum vascular dissection and take out the speciman are placed, typically at the fourth （for the upper and middle lobectomies ） or fifth （for the lower lobectomies ） intercostal space in the anterior axillary line. The endoscopic stapler was applied for the hilar vessel and bronchus dissection and occlusion. Results The VATS lobeetomies were performed on 12 left upper lobe, 13 left lower lobe, 11 right upper, 5 right middle lobe and 16 right lower lobe respectively. The drainage on the chest tube was about 50-150 ml/day and the average patients＇ stay time was 10.5 days. There were no mortality and morbidity. Conclusions Completely VATS lobectomies have the advantages of less hemorrhage, less painful, less admission time and fast recovery with the same clinical results. VATS lobectomies will be widely accepted. Special trained thoracic surgeons could become the master of this new Minimal invasive surgery technology.