全胸腔镜肺叶切除术在肺良恶性疾病治疗中的应用

Treatment of pulmonary benign and malignant disease with completed VATS lung lobectomy

目的探讨全胸腔镜(VATS)肺叶切除术治疗肺良恶性疾病临床疗效。方法总结2010年8月～2012年9月采用胸腔镜治疗17例肺良恶性疾病的临床资料,其中右肺上叶6例,右肺下叶2例,右肺中叶2例,右肺中上叶1例,右肺中下叶2例,左肺上叶2例,左肺下叶2例。术后病理:鳞癌11例,腺癌2例,支气管扩张2例,硬化性血管瘤1例,错构瘤1例。结果 1例因胸腔严重粘连,镜下处理困难而中转开胸行VATS辅助小切口手术,余16例全胸腔镜下完成。全组无围手术期死亡。手术时间80～240 min,平均140.2 min;手术出血量50～800 ml,平均150 ml;切除淋巴结4～25枚,平均15.2枚;胸腔引流管留置时间48～92 h,平均69.3 h;术后总引流量200～900 ml,平均300.5 ml;术后住院天数7～14 d,平均10.5 d。回访所有患者均生存良好。结论全胸腔镜肺叶切除治疗肺良恶性疾病能够完成肺门及纵隔淋巴结的清扫,同时具有手术创伤小,出血少,术后疼痛轻,恢复快,并发症少的优点。

Objective To evaluate the effects of completed video-assisted thoracoscopic surgery （VATS） lung lobectomy in the treatment of pulmonary benign and malignant disease. Method Seventeen patients with pulmonary benign and malignant disease from Jajuary 2011 to September undetwent completed VATS lobectomy. In these patients , there were 6 cases received right upper lobectomy,and right lower lobectomy in 2 cases, right middle lobectomy in 2 cases ,right middle and upper lobectomy in 1 cases,right middle and lower lobectomy in 2 cases, left upper lobectomy in 2 cases, left lower lobectomy in 2 cases, lobectomy in 2 cases. The postoperative pathology diagnosis was squamous cell carcinoma in eleven, abenocarcinoma in two, bronchiectasis in two, sclerosing hemangioma in one, harmatoma in one. Result One case changed to video-assisted minithoracotomy（VAMS） due to severe adhesion of thoracic cavity,the other 16 cases were successfully performed under completed VATS lobectomy. No motality or severe complications occurred peri-operatively. Operation time was 80 - 240 min, average140.2min ; surgical blood loss was 50 - 800ml, average 150ml; the number of clean up lymph node was 4 - 25, average 15.2 ; chest tube placement time was 48 - 72h, average 49.4h ; postoprative chest drainage volume was 200 - 900ml, average 300.5ml;post- operative hospitalization days was 7 -21d, average 12.5d. UP to now, all patients were good. Conclusion Completed VATS lobectomy in the treatment of pulmonary benign and malignant disease can complete mediastinal and hilar lymlh node dissection , and has micro- operation wound, low volume of blood loss, the pain of incisal opening is lighten, quick recovery, and low incidence rate of complication.