全胸腔镜下肺叶切除手术的扶镜技巧

摘要

目的 探讨全胸腔镜下肺叶切除手术中扶镜手的作用以及扶镜技巧.方法 2006年9月～2010年4月,我们完成全胸腔镜下肺叶切除术329例.通过胸部3个小切口非直视下完成肺叶解剖性切除,恶性肿瘤行淋巴结清扫.施行右肺上叶切除84例,右肺中叶切除32例,右肺下叶切除65例,左肺上叶切除73例,左肺下叶切除66例,联合肺叶或全肺切除9例.结果 全部患者手术均顺利,因淋巴结干扰、出血或肿瘤体积大等原因而中转开胸27例.手术时间(194.5±60.1)min(75～490 min),术中出血量中位数200 ml(20～1800 ml).术后胸腔闭式引流时间(7.4±3.4)d(1～22 d),术后住院时间(10.2±4.5)d(1～36 d).无严重并发症发生,无围手术期死亡患者.结论 全胸腔镜下肺叶切除手术中扶镜手需要熟知手术步骤,了解术者操作习惯,实时调节镜头焦距和角度,以配合术者进行手术.%Objective To discuss the skills of camera assistant for complete thoracoscopic lobectomy.Methods Between September 2006 and April 2010, a total of 329 patients underwent thoracoscopic lobectomy in our hospital.The lobectomy were completed via three mini incisions, and lymph nodes dissection were performed for the malignant cases.Upper right lobectomy was carried out in 84 patients, right middle lobectomy in 32, lower right in 65, upper left in 73, lower left in 66, and complex lobectomy or pneumonectomy in 9.Results 27 cases were converted to open thoracotomy.The mean operation time was ( 194.5 ± 60.1)minutes (range, 75 -490 minutes) , and the median blood loss was 200 ml (range, 20 - 1800 ml).The chest drainage lasted for (7.4 ± 3.4) days ( 1 - 22 days), and the patients were discharged from the hospital in ( 10.2 ± 4.5) days ( 1 - 36 days) after the surgery.No severe complications or perioperative death occurred in this series.Conclusion Thoracoscopic lobectomy is an intricate surgical procedure and needs more skills for camera assistant.