248例胸腔镜肺叶切除术手术心得

The Common Causes of Conversion of VATS during Operation for 248 Non-small Cell Lung Cancers

背景与目的早期肺癌胸腔镜肺叶切除术(video-assisted thoracic surgery,VATS)目前已经成为早期非小细胞肺癌(non-small cell lung cancer,NSCLC)治疗的常规术式。本文对中日友好医院胸外科已完成的胸腔镜肺叶切除术术中应急处理情况以及胸腔镜与传统开胸手术围手术期的相关因素进行分析总结。方法对2006年1月-2008年7月在中日友好医院胸外科进行的肺癌手术患者进行回顾性研究。结果共实施胸腔镜肺叶切除术248例,其中完全胸腔镜(complete video-assisted thoracic surgery,CVATS)组117例,胸腔镜辅助(assisted video-assisted thoracic surgery,AVATS)组131例。其中CVATS中转为AVATS或开放手术(open lobectomy,OPEN)共13例。中转术式的最常见原因依次为肺动脉或其分支出血、胸腔粘连、血管解剖变异、奇静脉出血、中叶静脉出血等。入组OPEN手术患者共129例。与OPEN组相比,VATS组的住院时间较短(20天vs27天,P=0.015)、术中失血量较少(197mLvs250mL,P=0.005),患者术后疼痛较轻(4.6vs6.2,P=0.003)。结论胸腔镜手术具有风险小、安全性较高、患者恢复快等特点,因此在一定范围内可以代替传统开胸手术。

Background and objective VATS-lobectomy has been used as regular surgical procedure clinically for non-small cell lung cancer. The aim of this study is to evaluate the surgical emergencies during VATS and the related fac-tors postoperatively. Methods Clinical data were reviewed for patients who were performed with pulmonary related surgery between January 2006 and July 2008 in our department. Results 248 （117 CVATS and 131 AVATS） VATS lobectomy were performed, including 13 cases that were transferred into AVATS or OPEN. The common related reasons were bleeding of pul-monary branches, adhesion, anatomic deformity, bleeding of azygos and bleeding of middle-lobe-vein. 129 thoracotomy cases were enrolled. Compared with OPEN surgery, VATS got the merits of short in-hospital duration （20 days vs 27 days, P=0.015）, less bleeding （197 mL vs 250 mL, P=0.005） and less pain （4.6 vs 6.2, P=0.003）. Conclusion VATS is a safe surgical procedure for early stage NSCLC with merits of lower morbidity and sooner recovery. So it could be concluded that in some circumstanc-es, VATS could be chosen as an alternate of thoractomy.