背景与目的：随着胸腔镜手术技术的提高，胸腔镜下解剖性肺段切除术日渐成熟。本文旨在研究胸腔镜肺段切除术用于治疗Ⅰ期肺癌患者的安全性、可行性及临床特点。方法：回顾性分析2008年3月—2014年1月复旦大学附属中山医院胸外科收治的临床诊断为Ⅰ期原发性支气管肺癌后接受胸腔镜解剖性肺段切除术的64例患者的临床资料，其中男性28例，女性36例，中位年龄59岁(39~86岁)。分析围术期各项参数。结果：64例患者顺利接受了胸腔镜解剖性肺段切除术。中位手术时间为120 min(90~240 min)，中位出血量为50 mL(10~200 mL)。术后中位胸管引流时间为3 d(2~7 d)，术后中位住院时间为5 d(3~23 d)。无围术期手术死亡病例，术后无严重并发症发生，无1例中转开胸，1例转为肺叶切除。51例毛玻璃样(ground glass opacity， GGO)病变患者的术后病理显示，浸润性腺癌30例，原位腺癌10例，微浸润腺癌6例，良性病变5例。结论：胸腔镜解剖性肺段切除对有经验的医师而言，是安全可行的，对临床Ⅰ期肺癌患者同时兼具了诊断和治疗的价值，尤其适用于GGO病变的患者。%Background and purpose:With the improvement of skill of video-assisted thoracic surgery, thoracoscopic anatomic segmentectomy becomes more and more mature. This paper aimed to study the safety, feasibility and clinical features of thoracoscopic anatomic segmentectomy for stageⅠ lung cancer.Methods:Data from 64 patients who was diagnosed as having clinicalⅠ stage lung cancer and received thoracoscopic anatomic pulmonary segmentectomy were retrospectively analyzed from Mar. 2008 to Jan. 2014. There were 28 men and 36 women with a median age of 59 years (39-86 years).Results:Sixty-four patients underwent thoracoscopic anatomic segmentectomy successfully. The median operative time was 120 min (90-240 min). The median blood loss in operation was 50 mL (10-200 mL). The median thoracic drainage time was 3 d(2-7 d). The median postoperative length of stay was 5 d(3-23 d). There was no postoperative mortality or severe complications. There was one conversion to lobectomy but no conversion to thoracotomy. There were 51 patients with ground glass opacity (GGO). Of the 51 patients, postoperative pathology showed invasive adenocarcinoma in 30, adenocarcinoma in situ in 10, minimally invasive adenocarcinoma in 6 and benign lesions in 5.Conclusion:Thoracoscopic anatomic pulmonary segmentectomy is a feasible and safe technique for a skilled doctor. Not only can it be a method of diagnosis, but also it can be a method of treatment for clinical stageⅠ lung cancer, especially for GGO in lung.
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