全胸腔镜下肺叶切除60例体会

Clinic experience of 60 patients pulmonary lobectomy under full thoraco-scopic

目的探讨全胸腔镜下肺叶切除术的可行性、安全性。方法我院共施行全胸腔镜下肺叶切除60例,其中施行右肺上叶切除15例,右肺中叶3例,右肺下叶16例,左肺上叶10例,左肺下叶16例,肺癌同时行纵隔及肺门淋巴结清扫。结果全组60例患者中57例在全胸腔镜下顺利完成肺叶切除,3例因肺门血管解剖困难,术中出血中转开胸手术。术后病理诊断为肺癌38例,结核瘤10例,炎性假瘤4例,支气管扩张8例。手术时间65～320 min(218±42 min),术中出血量150～800 ml(260±285 ml),无严重并发症发生,无手术死亡。术后发生肺不张2例,经纤维支气管镜吸痰后好转;肺断面持续漏气3例,予延长胸腔闭式引流2周后,无漏气后拔管。术后住院时间10±14 d(10.6±3.2)。结论全胸腔镜下肺叶切除是一种安全、有效的微创手术方式,主要适用于周围性肺癌和肺部良性疾病。

Objective To investigate the safety and efficacy of full thoraco-scoplc pulmonary lobeetomy. Methods 60 patients with pulmonary diseases were treated with full thoraco-scopic pulmonary lobectomy, which included 15 superior lobes of right lung, 3 mid- dle lobes of right lung, 16 inferior lobes of right lung, 10 superior lobes of left lung and sixteen inferior lobes of left lung. Systemic lymph node dissection was performed in primary lung cancer. Results Full thoraco-scopic pulmonary lobectomy was successfully performed in 57 patients and the rest 3 patients were changed to open thoracotomy due to bleeding in operation. 38 patients were diagnosed as primary lung cancer, 10 as tuberculoma, 4 as inflammatory pseudo-tumor, and 8 as brenchiectasis. The operative duration was from 65 minutes to 320 minutes （218 ±42 min）, and the blood loss was from 150ml to 800ml （260 ±285 ml）. There was no surgical mortality and severe com- plications. Two patients suffered from atelectasis after pulmonary lobectomy and were cured by phlegm suction with bronchoscopy. Three cases of air leakage were treated with closed drainage of thoracic cavity for two weeks. The postoperative hospital stay was 10 ~ 14 days. Conclusion The full thoraco-scopic pulmonary lobectomy is a safe and feasible surgical procedure with minimal invasiveness, which was advocated in selected peripheral typed lung cancer and benign pulmonary lesions.