全胸腔镜下肺癌根治术手术方法及器械改良的探讨

Investigate the methods of video-assisted thoracoscopic surgery lobectomy for lung cancer and modify the surgical instruments in the operation

目的探讨全胸腔镜手术行肺癌根治术手术方法及术中器械的改良。方法对2010年5月-2014年12月连续32例全腔镜肺叶切除术进行回顾总结。其中右上叶切除7例,右中叶切除4例,右下叶切除4例,左上叶切除7例,左下叶切除5例,左全肺切除2例,右上叶后段1例,右上叶前段1例,左上叶固有段1例。采用单向氏手法或者王氏手法或两者相结合的方法行手术治疗。结果 2例患者中转开胸。余胸腔镜完成的30例手术时间(205.8±54.9)min(160-280min),术中失血量30-600ml,平均为156.8ml,胸腔引流时间(7.1±4.5)d,术后住院时间(8.4±3.5)d,术后二进胸止血1例,无围手术期重大并发症,无围手术期死亡。结论胸腔镜下肺癌根治手术方法不要固定一种模式,随时根据术中情况调整手术方案,胸腔镜下手术器械需进一步改良以便适应胸腔内操作。

Objective To investigate the methods of video-assisted thoracoscopic surgery lobectomy for lung cancer and modify the surgical instruments in the operation. Methods Between May 2010 and December 2014,a total of 32 consecutive patiens underwent throcoscopic lobectomy in our hospital. By VATS,upper right lobectomy was carried in 7patients, right middle in 4,lower right in 4,upper left in 7, and lower left in 5,1eft pneumonectomy in 2, anterior segmental resection of upper right in 1,posterior segmental resection of upper right in 1,upper right postterior in 1,superior segmental resection of upper left in 1. We completed them by the methods of ＂single direction＂ or ＂wang＂ process or combinding the two ways. Results Only two cases were converted to open thoractomy. In the other 30 patiens,the mean operation time for the thoracoscopy was （205.8±54.9）minutes （range, 160- 280minutes）, and the mean blood loss was 156.8ml（rang, 50-650ml） in the series, the chest drainage lasted （7.1±4.5） days;the patiens were discharged from the hospital in （8.4±3.5）days after surgery. No severe complications or perioperative death occurred except one patient was reoperated because of bleeding. Conclusion Video-assisted thoracoscopic surgery lobectomy for lung cancer may not be processed by one fixed way,it should be adjusted according to anatomy during the operation. We should improve the instrument of VATS to better the operation.