完全电视胸腔镜下肺叶切除的临床体会

Clinical experience in complete video-assisted thoracoscopic lobectomy

目的：探讨完全电视胸腔镜肺叶切除的安全性及可靠性。方法：2012年9月-2013年8月,我科共施行全胸腔镜肺叶切除10例,男7例,女3例;年龄40-73岁。腋后线第九肋间稍偏后作为观察孔;腋前线及腋中线之间第四肋间4-5 cm切口,作为主操作孔;腋前线第七肋间作为副操作孔。施行解剖性肺叶切除,其中右上肺3例、右中肺1例、右下肺2例、左上肺1例、左下肺3例。结果：全组病人均顺利完成手术,无中转开胸,无围手术期死亡。手术时间105-240 min;术中出血量40-210 ml;清扫淋巴结4-12枚;胸腔引流管放置时间3-10 d;术后住院时间8-14 d。术后出现肺部感染1例,房颤1例,经积极治疗后痊愈。全组病人随访3-14个月无复发。结论：完全电视胸腔镜肺叶切除术是一种安全、有效、更加微创的术式。

Objective： To assess the safety and feasibility in application of complete video-assisted thoracoscopic lobectomy. Methods： Between September2012 and August 2013,we treated ten patients by complete video-assisted thoracoscopic lobectomy. The patients included seven men and three women with a mean age of 61. 5 years（ range,40- 73 years）,who underwent anatomic lobectomy by route of the incision for observation in the 9th intercostal space at the posterior axillary line,the major incision（ 4- 5 cm） made in the 4th intercostal space between anterior axillary line and mid-axillary line,and the assistant incision in the 7th intercostal space at the anterior axillary line. Excision of the right upper lobe in 3,right middle lobe in 1,right lower lobe in 2,left upper lobe in 1 and left lower lobe in 3. Results： The procedure was successfully completed in the total 10 cases without conversion to open surgery,no death occurred in perioperative period. The average operation time was 168. 9 min（ range,105- 240 min）,and average blood loss was 126 ml（ range,40-210 ml）. Average number of lymph nodes dissected was 8. 3（ range,4- 12） and average duration of drainage was 6. 5 days（ range,3- 10 days）. Postoperative hospital stay ranged from 8 to 14 days（ mean,11. 2 days）. Postoperative lung infection occurred in one case and arrhythmia occurred in another one,yet were managed by symptomatic treatment. There was no relapse for the total patients in follow-up by 3 to 14 months. Conclusion： The complete videoassisted thoracoscopic lobectomy is a safe and feasible surgical procedure with minimal invasiveness.