全胸腔镜下复杂肺叶切除术治疗早期非小细胞肺癌的安全性研究

Experience in completely video-assisted thoracoscopic complex lobectomy in early-stage non-small cell lung cancer

目的探讨全胸腔镜肺叶切除治疗非小细胞肺癌的可行性及安全性。方法选择2009年9月至2012年12月确诊的肺癌患者23例，男18例，女5例。年龄21～79岁，平均55．3岁。鳞癌17例，类癌1例，腺鳞癌2例．腺癌3例。IB期13例，IIA期4例，IIB期6例。行袖式支气管肺叶切除ll例，复合肺叶切除3例．合并肺动脉成形7例。结果全组均手术顺利，无围手术期死亡。采用间断吻合5例，吻合时间为62。85min。平均72．6min。连续吻合间断加固6例，吻合时间为33～42min，平均37．2min。全组术中出血100～900m1．平均420ml。每例患者清扫淋巴结17-24个，平均19．4个。胸腔闭式引流3—7d，平均5．0d。术后病理：支气管断端均未查见癌残留。结论全胸腔镜复杂肺叶切除术治疗早期非小细胞肺癌具有可行性，但远期疗效需进一步l临床试验证实。

Objective To summarize the outcomes of 23 cases of non-small cell lung cancer （NSCLC） treated with complete video-assisted thoracoscopic complex lobectomy in Beijing Chest Hospital, and to evaluate the Feasibility and safety of this procedure in VATs lobectomy. Methods Between 2009 and 2012, 23 cases of non-small cell lung cancer that has be treated with complex procedure in VATS lobectomy were reviewed. Eighteen patients were male, 5 were female. The median age was 55.3 years（21-79 years）. Among these patients, 11 were underwent sleeve lobeetomy（including 3 right upper lobes, 1 right middle lobes, 3 right lower lobes, 3 left upper lobes, 1 left lower lobes）, 5 bilateral lobectomy and 7 angioplasty. Seventeen patients had squamous carcinoma, 2 eases were adenosquamous carcinoma, 3 cases were adenocarcinoma, 1 case was careinoid. Thirteen cases were in stage IB, 4 cases were in stage IIA, 6 cases were in stage of liB. The operation procedure was complete VATS ]obectomy combined with systemic lymph node resection. Results All procedures were carried out smoothly without serious complications. The average duration of suture in interrupted suture group was 72.6 minutes （62-85 minutes）. The duration of operation in continuous suture plus interrupted suture group was 37.2 minutes （33-42 minutes）. The average blood loss was 420 m1（100-900 ml）. The median number of lymph nodes dissected was 16.9（17-24）. The median duration of postoperative chest tube drainage placement was 5 days（3-7 days）. Conclusion Completely Video-assisted thoracoscopic complex lobectomy procedure is safe and effective in treating patients with early stage non-small cell lung cancer.