全电视胸腔镜下肺叶切除35例分析

Analysis of 35 cases with VATS lobectomy

目的探讨全电视胸腔镜(video-assisted thoraeic surgery,VATS)手术行肺叶切除的安全性和对早期肺癌的疗效。方法连续完成全电视胸腔镜肺叶切除35例,其中原发周围性肺癌28例,良性肿瘤7例。胸腔镜观察孔位于腋中线第7肋间,第一操作孔(主操作孔)位于腋前第3肋间2.5～3cm(上、中叶)或第4肋间(下叶)、第二操作孔肩胛线与腋后线之间第9肋间1.5～2cm;不用胸撑开器。施行右肺上叶切除10例,右肺中叶切除2例,右肺下叶切除5例,左肺上叶切除10例,左肺下叶切除8例。恶性肿瘤同时施行标准淋巴结清扫。结果并发右下肺炎1例,右肺中叶肺不张1例,均经保守治疗而痊愈。无二次手术,无围手术期死亡。随访1～15个月,1例术后12个月发生远处转移。结论全电视胸腔镜手术治疗早期肺癌早期疗效肯定,行肺叶切除手术创伤小、术中出血少、术后疼痛轻、恢复快,安全。

Objective To explore the effect of whole video-assisted thoracoscopic（video-assisted thoraeic surgery,VATS） on lobectomy surgery of early lung cancer.Methods All consecutive complete VATS lobectomy made the Central Plains around 35 cases of lung cancer in 28 cases,benign tumors in 7 cases.Thoracoscopic observation hole in the 7th intercostal space midaxillary line,the first operation hole（the primary operating hole） is located in the former No.3 axillary intercostal 2.5-3cm（last,middle） or 4 intercostal（lower lobe）,the second operation hole scapular line and the posterior axillary line between the 9th intercostal 1.5-2 cm;without chest distraction device.Implementation of right upper lobe resection in 10 patients,right middle lobe resection in 2 cases,5 cases of right lower lobe,left upper lobe resection in 10 cases,8 cases of left lower lobe.Implementation of standards for malignant lymph nodes at the same time.Results 1 case of pneumonia complicated by right lower,right middle lobe atelectasis in 1 case,were cured by conservative treatment.No second surgery,no perioperative deaths.Follow-up 1-15 months,1 T1N 2M 0 after 12 months of distant metastasis.Conclusion VATS lobectomy patients with early lung cancer,surgical trauma,less blood loss,postoperative pain,quick recovery,security.