胸腔镜解剖性肺切除手术常见意外情况及其处置

Troubleshooting Common Unexpected Situations during Thoracoscopic Anatomical Pulmonary Resection

现代意义上的胸腔镜肺外科始于20世纪90年代初,经过20余年发展,手术技术已臻成熟,同时也有了丰富的临床数据积累。以胸腔镜为代表的微创技术在早期非小细胞肺癌及肺部良性疾病的外科治疗、肺部疾病诊断等方面的应用均已得到公认,也是上述情况的首选手术方法。随着胸腔镜解剖性肺切除手术的普及,文献中也逐渐有了一些临床实践中意外情形的报道,涉及解剖异常、病变自身相关因素、手术操作及技术等多方面,但目前少有对胸腔镜解剖性肺切除手术中意外情形的系统梳理,本文拟结合自身临床实践及文献报道,对这方面内容进行总结,为临床工作提供参考。

The history of modern thoracoscopic pulmonary surgery could date back to the 1990 s, and the related surgical technique has been matured after 20 years＇ development. Meanwhile, large amount of clinical data has been collected. Minimally invasive thoracic surgery represented by the thoracoscopic approach has been universally accepted as the preferred choice for the surgical treatment of early-staged non-small cell lung cancer and pulmonary benign diseases, and for the diagnosis of pulmonary diseases. With the generalization of thoracoscopic anatomical pulmonary resection, some unexpected situations during clinical practice has been reported in literatures, with issues involving anatomical variation, pathological factors, and surgical techniques. However, the systemic summary of the unexpected situations during thoracoscopic anatomical pulmonary resection is lacking until now. The present review, therefore, aims to summarize accidental issues and troubleshooting these unexpected situations on the basis of our own clinical practice and literature reports.