支气管袖式肺叶切除治疗中央型肺癌的手术技巧和围术期处理

Surgical techniques and peri-operative management of sleeve lobectomy for central lung cancer

目的探讨支气管袖式肺叶切除治疗中央型肺癌的手术技巧和围术期处理经验。方法回顾分析我院2007年1月至2011年12月收治的中央型肺癌施行支气管袖式肺叶切除术78例,分析术中术后并发症和术后康复情况,总结手术技巧和围术期的处理经验。结果全组均顺利完成手术,其中61例(78.3%)常规开胸手术,17例(21.7%)在胸腔镜辅助下完成。单肺叶切除72例(92.3%),双肺叶切除6例(7.7%);联合肺动脉成形18例(23.1%),其中肺动脉袖式切除3例(3.8%)。全组无手术死亡,术中大出血2例(2.6%),术后出现支气管胸膜瘘1例(1.3%),心功能不全3例(3.8%),各种心律失常13例(16.7%),肺部感染5例(6.4%),肺不张6例(7.7%)。所有患者均经积极处理后顺利度过围手术期。结论恰当的术中和围术期处理有利于防治支气管袖式肺叶切除的并发症。胸腔镜辅助支气管袖式肺叶切除具有显露充分和创伤较小等优点。

Objective To explore surgical techniques and perioperative management of sleeve lobectomy for central lung cancer. Meth- ods From January 2007 to November 2011,78 eases with central non-small cell lung cancer in our hospital received sleeve lobeetomy. The clinical outcomes including intra-and post-operative complications, rehabilitation after surgery were evaluated. The surgical techniques and experience of peri-operative management for patients were summarized. Results Operations were successfully performed in all cases. 61 ca- ses were performed by thoracotomy （78.3%）, 17 cases treated by video-assisted mini-thoracotomy （VAMT, 21.7% ）. 72 cases （92.3%） were removed single lobe, 6 cases （7.7%） received double lobe resection. In all of the cases, 18 operations of sleeve lobectomy were com- pleted combined with pulmonary arterioplasty （23.1% ） , 3 cases combined with pulmonary artery sleeve resection because of pulmonary ar- tery invasion by tumor. There was no peri-operative death. 2 cases were complicated with intra-and post-operative hemorrhea （ 2.6% ） , 1 case with bronchopleural fistula （ 1.3% ）, 3 with heart failure （3.8%）, 13 with cardiac dysrhythmia （ 16.7% ）, 5 with pulmonary infection （6.4%） and 6 with atelectasis （7.7%）. All patients went through peri-operative period smoothly by active clinical treatment. Conclusion Appropriate surgical techniques and peri-operative management could prevent and control complications of sleeve lobectomy. Operation via VAMT might offer full exposure and reduce operative invasiveness.