电视胸腔镜联合前/后径路在肺上沟瘤切除术中的临床应用

Anterior or Posterior Approach with Video-assisted Thoracoscopic Surgery for Superior Sulcus Tumors

背景与目的肺上沟瘤的外科手术治疗具有挑战性。胸腔镜辅助下手术治疗肺上沟瘤的临床研究较少。本研究旨在初步评估胸腔镜应用于肺上沟瘤切除术中的可行性及安全性。方法 2010年1月-2013年6月在重庆医科大学附属第一医院胸心外科确诊的肺上沟瘤患者10例,最终有6例接受外科手术治疗,包括胸腔镜联合前径路3例及联合后径路3例。研究指标包括:1围手术期死亡率;2手术对肿瘤切除的完整性;3手术的一般资料及术后并发症;4手术后1年复发及转移情况。结果无围手术期死亡患者。肿瘤及受累胸壁均为完整切除。手术平均时间为242 min。术中平均出血量为308 m L。平均住院时间为14 d。1例患者术后出现肺部感染,经使用抗生素治愈。术后无严重并发症。所有患者随访1年均无局部复发或远处转移。结论胸腔镜联合前/后径路行肺上沟瘤切除术具有实用价值,符合术者视野角度和操作习惯,便于确定胸壁切除的准确范围,有利于肺上沟瘤手术的安全、规范实施。

Background and objective The surgical resection for pancoast tumors remains challenging. There are only few reports explaining the use of VATS in the treatment of Pancoast tumors. The aim of this study is to assess whether the use of video-assisted thoracoscopic surgery（VATS） for the surgical treatment of Pancoast tumors was feasible and safe. Methods Between Janunary 2010 and June 2013, ten patients who were diagnosed as Pancoast tumors were recruited. Six patients were accepted for surgical treatment either through an anterior（n=3） or a posterior approach（n=3） combined with VATS. The observation index of this study included： Operation safety and mortality; The integrity of the tumor resection; General data of operation and postoperative complications; Tumor recurrence and metastasis at twelve months after operation.Results There were no perioperative deaths. The average time of operation time was 242 min. The radical en bloc resection of the involved chest wall were done in each patients. The average amount of blood loss was 308 m L and the average time of hospital stay was 14 d. Only one patient had postoperative pneumonia and recovered after use of antibiotics. There was none of severe postoperative complications. No patient developed a local recurrence or distant metastasis within twelve months. Conclusions The use of VATS has practical value in the management of Pancoast tumors. It is useful to make an accurate extent of the resection of chest-wall and provides a better exposure. Anterior or posterior approach with VATS surgery can facilitate the safety management of Pancoast tumors.