全胸腔镜全肺切除治疗非小细胞肺癌

摘要

目的 探讨全胸腔镜全肺切除在非小细胞肺癌手术治疗中的安全性和有效性.方法 2009年1月至2012年6月共施行全胸腔镜下全肺切除术治疗非小细胞肺癌16例,年龄46～ 83岁,平均62.2岁.手术全部通过3个胸腔镜切口完成,不撑开肋间,完全在胸腔镜视野下使用腔镜器械进行解剖性全肺切除和系统性淋巴结清扫.结果 全组手术过程顺利,未发生严重并发症,无围手术期死亡,无中转开胸病例.平均手术(174.6±52.7)min；无输血病例,术中平均出血(121.8±87.5) ml；每例清扫淋巴结平均(5.2±1.1)组,清扫淋巴结平均(16.0±3.2)个；术后平均胸腔闭式引流(4.2±1.8)天；术后平均住院(13.0±3.1)天.结论 全胸腔镜下全肺切除治疗非小细胞肺癌安全可行,并未增加全肺切除术围手术期风险,值得总结经验并加以推广应用.%Objective To evaluate the feasibility and safety of the completely thoracoscopic pneumonectomy for nonsmall cell lung cancer (NSCLC).Methods From January 2009 to June 2012,16 patients with NSCLC received completely thoracoscopic pneumonectomy.Three incisions were made in the thoracoscopic pneumonectomy.Without softening the intercostal space,we used thoracoscopic equipment for anatomic lung resection under thoracoscopic vision totally and the sequence of operations of systematic lymph node dissection was basically the same as conventional thoracotomy.Evaluation indicators including lymph node dissection,operation time,bleeding loss,time of drainage,pathological staging,hospitalization time,and postoperative complications.Results All 16 patients with non-small cell lung cancer were operated safely,without serious complications and death in the period of operation.There was no case of conversion to thoracotomy.The mean operation time was(174.6 ± 52.7) minutes.There was no blood transfusion cases in the completely thoracoscopic group,whose blood loss is (121.8 ± 87.5) ml.The mean groups of lymph nodes dissection was (5.2 ± 1.1),The mean time of drainage was (4.2 ±1.8),The mean hospitalization time was (13.0 ± 3.1).Conclusion Completely thoracoscopic pneumonectomy for non-small cell lung cancer should achieve the same objective of thoracotomy in terms of effectiveness and thoroughness.By no increasing perioperative risk,it is worth summarizing the experience of completely thoracoscopic pneumonectomy for non-small cell lung cancer and promoting it to application.