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11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100～900ml，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 lobectomy （including 3 right upper lobes, 1 right middle lobe, 3 right lower lobes, 3 left upper lobes, 1 lett lower lobe）, 5 bilateral lobectomy and 7 angioplasty. Seventeen patients had squarnous carcinoma, 2 cases were adenosquamous carcinoma, 3 cases were adenocarcinoma, 1 case was carcinoid. Thirteen cases were in stage ⅠB, 4 cases were in stage ⅡA, 6 cases were in stage of ⅡB. The operation procedure was complete VATS lobectomy combined with systemic lymph node resection. Results All procedures were carried out smoothly without serious compications. 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 ml（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.