全胸腔镜肺叶切除治疗肺良性疾病

Treatment of pulmonary benign disease with completely VATS lobectomy

目的探讨全胸腔镜肺叶切除术(VATS)治疗肺良性疾病的可行性、安全性。方法总结47例采用胸腔镜肺叶切除治疗的肺良性疾病患者的临床资料,其中支气管扩张18例,多发肺囊肿6例,结核瘤6例,炎性假瘤10例,肺曲霉菌病4例,肺隔离症3例。结果 3例(6.38%)因为肺动脉血管严重粘连或术中分离出血,镜下处理困难而中转开胸行VATS辅助小切口手术;余44例全胸腔镜下完成:切除范围包括右肺上叶5例,右肺中叶3例,右肺中上叶2例,右肺中下叶1例,右肺下叶10例,左肺上叶7例,左肺下叶13例,左肺下叶+舌段3例。全组无围术期死亡。并发症7例(14.89%):肺不张1例,肺持续漏气(>10 d)3例(引流10～18 d后自愈),心律不齐3例。平均手术时间172 min(86～269 min),术中平均失血量148 ml(100～1200 ml),术后平均总引流量781 ml(200～2200 ml),术后平均引流管保留时间4.25 d(3～18 d),术后平均住院时间8.91 d(6～20 d)。结论全胸腔镜肺叶切除治疗肺良性疾病是可行和安全有效的。

Objective To evaluate the feasibility,safety and efficacy of completely thoracoscopic lobectomy in the treatment of chronic infectious pulmonary diseases.Method Forty-seven patients with benign pulmonary diseases from February 2007 to June 2011 underwent complete video-assisted thoracoscopic lobectomy,including 18 bronchiectasis,6 pulmonary cyst,6 tuberculoma,10 inflammatory pseudo-tumor,3 pulmonary sequestration,2 pulmonary aspergillosis.Results cVATS lobectomy was successfully performed in 44 patients,including 5 right upper lobectomies,3 right middle lobectomies,2 right middle and upper lobctomies,1 right middle and lower lobectomy,10 right lower lobectomies,7 left upper lobectomies,13 1eft lower lobectomies,3 left lower lobctomies plus lingular segmental resection.Threecases changed to aVATS（6.83%） due to bleeding caused by severe adhesion of blood vessels.No mortality or severe complications occurred peri-operatively.The mean time of cVATS was 172 min（ranged from 86 to 269 min）,the average volume of bleeding was 148 ml（range 100~1200 ml）,the average volume of drainage was 781 ml（range 200~2200 ml） and the average duration of drainage was 4.25 days（range 3~18 days）.The average postoperative hospital stay was 8.9 days（range 6~20 days）.Conclusion Lobectomy through cVATS is a safe and effective procedure for patients with benign pulmonary diseases.