胸腔镜辅助小切口手术治疗老年人胸部肿瘤

Video-assisted small incision thoracic operation for the treatment of elderly patients with thoracic tumor

目的 探讨胸腔镜辅助小切口手术治疗老年人胸部肿瘤的手术方法及应用价值。 方法 应用胸腔镜辅助小切口手术治疗老年人胸部肿瘤 35 6例 ,其中肺癌 2 2 8例 ,肺部良性肿瘤 2 3例 ,食管癌 6 2例 ,纵隔肿瘤 39例 ,胸膜肿瘤 4例。 结果 全组无手术死亡 ,食管癌手术时间 3 5～ 4 5h ,平均 4 0h ;其他手术时间 0 5～ 3 5h平均 2 0h。术中延长手术切口至 12cm 2 3例 ,占 6 5 % ,均为中央型肺癌患者 ,需作支气管或肺血管成形。开胸时间 5～ 12min ,平均 8min ;关胸时间 15～ 30min ,平均 2 3min。开胸过程出血量少于 30ml,切口均Ⅰ期愈合。胸腔引流时间 2～ 7d ,平均 2 5d、住院天数 5～ 19d ,平均 11 2d。 结论 胸腔镜辅助小切口手术治疗老年胸部肿瘤具有创伤小、恢复快、出血少 ,对心肺功能影响小 ,开关胸时间短 ,术后并发症少 ,手术适应证更广等优点。

Objective To evaluate the clinical significance of surgical treatment for elderly patients with thoracic tumor using thoracoscopy combined with small incision. Methods From July 1997 to August 2003, video-assisted small incision thoracic operation were performed for 356 elderly patients with thoracic tumor including 228 lung cancers and 23 benign tumors, 62 esophageal cancers, 39 mediastinal tumors, and 4 pleural neoplasms. Results The mortality and morbidity showed no association with surgical procedures. The mean duration of postoperative chest tube drainage was 2.5 days and hospital stay was 11.2 days. Conclusions Video-assisted small incision thoracic operation for elderly patients with thoracic tumor has many advantages, such as minimal injury, quick recovery, less bleeding, short operation period and it influences less to lung and heart functions. It causes less complications and is of wide indications.