单向式全胸腔镜下肺癌根治术的临床研究

Clinical Study of LVATS Radical Operation for Lung Cancer

目的探讨单向式全胸腔镜下肺癌根治术的治疗体会。方法回顾2009年4 月~ 2012年1 2 月施行的6 4 例单向式全胸腔镜下肺癌根治术，完成左上肺叶切除术9 例，左下肺叶切除术2 0 例，右上肺叶切除术1 2 例，右肺中叶切除术2 例，右下肺叶切除术2 1 例，所有肺叶切除过程采用单向推进，上叶、中叶从前到后，下叶从下到上。结果全组无死亡病例，2 例因淋巴结与肺动脉粘连紧密难以分离、1 例因肺动脉分支撕裂致出血改为胸腔镜辅助小切口。术后出现心律失常1 例，肺部感染1 例。术后随访1 ~ 3 年，1 年存活率100% ; 3 年存活率93% 。结论单向式全胸腔镜肺癌根治术安全、有效，简化了手术程序，值得大力推广。

Objective To investigate the effectiveness of single - direction complete video - assisted thoracoscopiclobectomy (LVATS) for lung cancer. Methods 64 patients who underwent LVATS for lung cancer were included from Apr.2009 to Dec. 2012, with upper left lobectomies in 9 cases, left inferior lobectomies in 20 ones, upper right lobectomies in 12ones, resections of middle lobe of right lung in 2 ones and right inferior lobectomies in 21 cases. The single - direction propulsionwas used in all procedures, with the upper and middle lobes propelled from anterior to posterior and the lower lobepropelled from up to down. Results There was no death cases in this group. The single - direction thoracoscopic radical operationwas successfully completed. The thoracoscope - assisted minithoracotomies were performed in 2 patients because of adhesionof their lymph nodes and pulmonary artery, and in 1 patient because of pulmonary artery hemorrhage. Serious complicationsincluding arrhythmia (1 patient) and pulmonary infection (1 patient) occurred after operation. The 1 - 3 years follow- ups showed that the one - year survival rate was 100% and the three - year survival rate was 93% . Conclusion The single- direction complete video - assisted thoracoscopic lobectomy for lung cancer is a safe and effective procedure and it cansimplify the surgical procedure.