连续100例全胸腔镜下肺叶切除术的临床分析VIP免费

·肺外科·连续100例全胸腔镜下肺叶切除术的临床分析李剑锋杨帆李运王俊刘军姜冠潮赵辉刘彦国周足力卜梁(北京大学人民医院胸外科胸部微创中心,北京100044)摘要:目的探讨全胸腔镜下肺叶切除术的安全性和可靠性,评价其手术适应证。方法2006年9月至2008年6月我院共施行全胸腔镜下肺叶切除100例,男46例,女54例;年龄18～82岁(60.1±12.5岁)。所有患者均为需行肺叶切除的肺局限性病变,包括拟诊原发周围型肺癌85例,良性疾病15例。手术通过胸部3个微小切口全程非直视下完成,均为解剖性肺叶切除,恶性肿瘤同时施行淋巴结清扫;施行右肺上叶切除25例,右肺中叶切除14例,右肺下叶切除22例,左肺上叶切除18例,左肺下叶切除21例。结果中转开胸3例。术后诊断:原发性肺癌81例,肺内淋巴瘤1例,透明细胞癌肺转移1例,良性疾病17例。术后发生并发症5例,分别为肺不张2例,短暂呼吸机辅助1例,肺炎1例,乳糜胸1例,均经保守治疗后痊愈,无二次手术;本组无严重并发症及围手术期死亡。手术时间186.4±52.9min(60～300min),出血233.9±275.9ml(50～750ml),输血1例,胸腔引流时间7.1±3.0d,术后住院时间9.5±3.2d。随访1～27个月,原发性肺癌中2例分别于术后15个月和3个月发生远处转移,其余患者无复发、转移。结论全胸腔镜下肺叶切除术是一种安全、有效、更加微创的术式,适于经选择的早期周围型肺癌和需要肺叶切除的良性疾病患者。关键词:胸腔镜;肺叶切除术;适应证中图分类号:R734.2文献标识码:A文章编号:1007-4848(2009)01-0001-05ClinicalAnalysisof100ConsecutiveCompletelyThoracoscopicLobectomyLIJian-feng,YANGFan,LIYun,WANGJun,LIUJun,JIANGGuan-chao,ZHAOHui,LIUYan-guo,ZHOUZu-li,BULiang.(DepartmentofThoracicSurgery,People'sHospital,PekingUniversity,Beijing100044,P.R.China.E-mail:drlijf@vip.sina.com)Abstract:ObjectiveToinvestigatethesafetyandefficacyofcompletelythoracoscopiclobectomyandtheindicationsofthisprocedure.MethodsBetweenSep.2006andJun.2008,100consecutivepatients(46men,54women,medianage60.1±12.5years,rangefrom18to82years)underwentcompletelythoracoscopiclobectomy.Allcandidateswereeitherperipheralpulmonarynodulessuspectedoflungcancer(85pts.)orbenignlesions(15pts.)localizedwithinsinglelobewhoneededtoreceivelobectomy.Thelobectomywascompletedthroughthreetinyincisionsintheintercostalspace.Anatomiclobectomieswerecarriedoutinallcasesandsystemiclymphnodedissectionwasperformedinmalignancies.Thisgroupconsistedoflobectomiesofrightupperlobe(n=25),rightmiddlelobe(n=14),rightlowerlobe(n=22),leftupperlobe(n=18),andleftlowerlobe(n=21).ResultsAllproceduresweresuccessfullycompletedexceptfor3conversionstothoracotomy.Postoperativediagnosiswereprimarylungcancer(n=81),lymphoma(n=1),metastasisofclearcellcarcinomafromkidney(n=1),and,benignlesions(n=17).Fivepatientshadmildcomplicationsinwhichtwohadatelectasis,oneneededtemperatelymechanicalventilation,onehadpneumoniaandonehadchylothorax.Allweretreatedconservativelywithoutre-operation.Nooperativemortalityorseriouscomplicationsoccurredinthisgroup.Theoperativedurationwas186.4±52.9min(rangefrom60to300minutes).Thebloodlosswas233.9±275.9ml(rangefrom50to750ml),andonlyonecaseneededbloodtransfusion.Chestdrainagetimewas7.1±3.0days.Postoperativehospitalstaywas9.5±3.2days.Followed-uptimewasfor1to27months,metastasishappenedintwopatientswithprimarylungcancer15and3monthsseparatelyafteroperation.ConclusionThecompletelythoracoscopiclobectomyisasafeandfeasiblesurgicalprocedurewithminimalinvasiveness.Theadvocatedindicationsincludeselectedperipheraltypedearlystagelungcancerandbenignpulmonarylesionswhichneedlobectomy.Keywords:Video-assistedthoracoscopicsurgery;Lobectomy;Indication胸腔镜肺叶切除术(Video-ass...