单操作孔胸腔镜手术在肺癌治疗中的应用

Single Utility Port Complete Thoracoscopic Surgery for Lung Cancer

目的 探讨单操作孔胸腔镜（Video-Assisted Thoracoscopic Surgery,VATS）手术治疗肺癌的安全性及临床效果.方法 2009年9月-2011年10月解放军总医院胸外科应用单操作孔VATS行解剖性肺叶切除术并纵隔淋巴结清扫,治疗肺癌183例.结果 183例患者中行左肺上叶切除38例,左肺下叶切除31例,右肺上叶切除53例,右肺中叶切除16例,右肺下叶切除43例,右肺中上叶切除1例,右肺中下叶切除1例.全部患者手术过程顺利,平均手术时间（136.7±29.2）min,胸腔引流管平均拔除时间（4.1±1.6）d,术后平均住院时间（7.2±2.3）d,平均每例清除淋巴结11.9枚.TNM分期：ⅠA期117例、ⅠB期22例、ⅡA期18例、ⅡB期5例、ⅢA期21例.无围手术期死亡,术后并发症12例（6.6%）,其中肺不张6例、房颤5例、二次开胸止血1例.结论 单操作孔VATS治疗肺癌安全、可靠,术后并发症少、病人恢复快.

Objective To study safety and clinical results of single utility port video - assisted thoracoscopie surgery（VATS） for lung cancer. Methods From September 2009 to Octomber 2011,183 lung cancer patients underwent lobectomy and dissection of systematic mediastinal lymph nodes with single utility port video - assisted thoracoscopic surgery. Results Of the 183 patients,38 left upper lobectomy,31 left lower lobectomy,53 underwent right upper lobectomy, 16 right middle lobectomy ,43 right lower lobectomy,2 bilobectomy. The procedure was successful in all patients with no patient transferred for open thoracotomy. The mean operative time was（ 136.7 ±29.2）rain,the average number of dissected lymph nodes from each patient was 11.9. The lung cancer was classified as TNM stage I A, I B,II A, II B, and III A in 117,22,18,5 and 21 cases, respectively. No post - operative death occurred. The postoperative complications occurred in 12 cases, atelectasis 6 cases, arrhythmia 5 cases, and bleeding 1 case. Conclusion Single utility portal VATS is technically safety to perform complete lobectomy and dissection of systematic mediastinal lymph nodes for lung cancer, and with the advantages of lower morbidity and rapid postoperative recovery.