全胸腔镜解剖性肺段切除治疗肺部疾病的早期结果

Complete video-assisted thoracoscopic anatomic segmentectomy for pulmonary diseases： the early experiences

目的探讨胸腔镜解剖性肺段切除治疗肺部疾病的可行性及安全性。方法2009年11月至2011年7月共对20例患者施行全胸腔镜解剖性肺段切除，其中男性3例，女性17例；年龄32～81岁，平均53岁。病变包括原发性非小细胞肺癌12例，肺良性疾病7例，肺转移瘤1例。切除部位包括：右上肺后段3例、右上肺尖段4例、右上肺前段1例、右下肺背段2例，左上肺舌段5例、左上肺三段切除3例、左下肺背段2例。3例支气管扩张患者同时行肺叶切除，1例左上肺舌段肺腺癌患者同时行胸腺切除术。原发性肺癌术后病理分期（UICC，2009年）Ia期10例，Ib期2例。结果全组手术时间120—235min，中位数155min；术中出血量10—600ml，中位数50ml；术后住院时间3～9d，中位数6d；术后胸腔引流时间1—6d，中位数3d。全组无围手术期死亡。围手术期并发症包括：术中出血1例，出血600ml，胸腔镜下完成止血，未输血；术后咯血痰2例，口服止血药好转；持续漏气（胸腔引流时问35d）1例，给予50％葡萄糖溶液胸腔灌注后愈合；皮下气肿1例，未作特殊处理好转。结论全胸腔镜解剖性肺段切除治疗肺部良性疾病及早期肺癌技术上可行，手术时间可以接受，术中失血少，并发症少，术后住院时间短。

Objective To evaluate the safety and feasibility of video-assisted thoracic surgery （VATS） anatomic segmentcctomy for pulmonary diseases. Methods Between November 2009 and July 2011, 20 patients received consecutive VATS anatomic segmentectomies by single surgical group. There were 3 male and 17 female, aging from 32 to 81 years with a mean of 53 years. The patients included 12 cases of non-small eel1 lung cancer （NSCLC） （5 cases of bronehioloalveolar carcinoma, 6 cases of adenocarcinoma, and 1 case of squamous cell carcinoma）, 7 cases of benign diseases （3 cases of bronchiectasis, 2 cases of inflammatory pseudotumor, l case of tuberculosis, and 1 case of sclerosing hemangioma） and I case of metastasis tumor. The locations of resected segments included 1 anterior segment, 3 posterior segments, 4 apical segments, and 2 superior segments in the right side ; and 5 lingular segments, 3 trisegments, and 2 superior segments in the left side. Simultaneously, 3 patients with bronchiectasis underwent segmentectomy and lobectomy, 1 of 6 patients with adenocarcinoma underwent lingulectomy and thymectomy. The pathological TNM stages of 12 NSCLC patients were 9 cases of TlaNOM0, 1 case of TlbNOM0 and 2 cases of T2aNOM0. Results Of these 20 patients, the median operative time was 155 minutes （range, 120 to 235 minutes） , the median blood loss was 50 ml （range, l0 to 600 ml） , the median drainage duration was 3 d （range, 1 to 6 d） , and the median hospital stay was 6 d （range, 3 to 9 d）. One patient who had undergone lingulectomy had a 600 ml intraoperative bleeding from lingular artery, and the bleeding was controlled by suturing the rupture under VATS. Bloody sputum occurred in 2 patients, prolonged air leak occurred in one patient for 5 days, and one patient developed subcutaneous emphysema that spontaneously resolved. No mortality was observed for 30 days after the surgery. Conclusions VATS anatomic segmentectomy is a feasible and safe technique with acceptable operative time, less blood loss, fewer complications, and shinier hospital stay.