完全胸腔镜支气管袖式成形肺叶切除术治疗中央型肺癌

Complete Video-assisted Thoracoscopic Surgery of Sleeve Lobectomy for Central Type Lung Cancer

目的探讨完全胸腔镜支气管袖式成形肺叶切除术的可行性。方法 2012年2月~2014年7月,对7例肺癌行胸腔镜袖式肺叶切除术,其中6例行右肺上叶切除支气管袖式成形术,1例行左肺上叶切除支气管袖式成形术。均采用＂三孔法＂完全胸腔镜下行肺叶动脉、静脉、叶间裂切除,并袖式切除支气管。采用连续缝合法,自支气管后壁开始,完全屏视下经主操作孔行支气管端端吻合术。结果 7例均完成肺叶切除、支气管袖式成形重建及系统性淋巴结清扫,手术时间110~260 min,平均174 min;支气管吻合时间18~76 min,平均45 min。术后无吻合口漏、肺不张、肺部感染等严重并发症,无围手术期死亡。术后病理：鳞癌5例,腺癌1例,类癌1例。7例随访7~34个月,平均19个月,均存活,无刺激性咳嗽、吻合口狭窄等并发症。结论全胸腔镜袖式成形肺叶切除术治疗中央型肺癌可行。

Objective To explore the feasibility of video-assisted thoracic surgery（ VATS） of sleeve lobectomy.Methods Seven patients underwent VATS of sleeve lobectomy from February 2012 to July 2014,including 6 cases of thoracoscopic right upper sleeve lobectomy and 1 case of thoracoscopic left upper sleeve lobectomy. The VATS was performed with ＂three port method＂. The lobar artery and vein and interlobar fissure were resected and then the sleeve lobectomy was performed. Bronchial anastomosis was conducted under the complete monitor view. Results The sleeve lobectomy with lymph node dissection was completed successfully in all the 7 cases. The operating time was 110- 260 min（ mean,174 min）,and the bronchus suturing time was 18- 76 min（ mean,45 min）. There were no serious complications after surgery,such as anastomotic leakage,atelectasis,or pulmonary infection.No peri-operative death happened. Postoperative pathological outcomes showed 5 cases of squamous carcinoma,1 case of adenocarcinoma,and 1 case of carcinoid. Conclusion Complete VATS of sleeve lobectomy is a feasible option for central type lung cancer.