胸腔镜顺行左肺上叶切除法与常规胸腔镜切除法的对比研究

A COMPARATIVE STUDY OF DIRECT HILAR RESECTION VERSUS CONVENTIONAL PROCEDURE BY VIDEO-ASSISTED LEFT UPPER LOBECTOMY

目的 :评价胸腔镜顺行左肺上叶切除法的可行性与效果。方法 :将 12例需行单纯左肺上叶切除术的病人按时间顺序平均分为两组 :一组按常规胸腔镜肺叶切除方式行左肺上叶切除术 (对照组 ) ,另一组先按由前到后的顺序处理肺门诸结构 ,然后再处理肺裂和粘连的方式行胸腔镜左肺上叶切除术 (研究组 )。比较两组病人围术期情况。结果 :对照组中 1例因粘连多、转用“顺行切除法”完成外 ,其余手术均按计划完成。围手术期均未输血 ,无死亡。与对照组比 ,研究组的手术时间短 ,失血量少 ,但术后住院日无差异。结论 :胸腔镜辅助下先处理肺静脉和支气管、再处理肺动脉各分支、最后处理粘连及肺裂的顺行左肺上叶切除法可明显缩短手术时间 ,减少失血量。

Objective To evaluate direct hilar resection versus conventional procedure for video-assisted left upper lobectomy. Methods Twelve patients who needed to undergo left upper lobectomy were equally divided into test group or control group. In the test group, the lobectomy was achieved by dividing the hilar structures of the left upper lobe in the order of 'anterior' first, 'posterior' last, and then the fissure and pleural adhesion. In control group, the upper lobectomy was achieved in conventional 'retrograde' dividing order, i.e. dividing the pleural adhesion, the fissure, and then the hilar structures of the left upper lobe. Operating time, blood loss during operation, morbidity,mortality and postoperative hospital stay were studied between the groups. Results No difference was observed in morbidity, mortality and postoperative hospital stay. The test group has the following advantages over the control: less blood loss during surgery ( P < 0.01);less operating time ( P < 0.01).Conclusion The direct hilar resection procedure for VATS upper lobectomy of left lung is a timesaving and minimally invasive lobectomy.