肺癌主支气管癌的全胸腔镜支气管成形术

摘要

目的 探讨全胸腔镜支气管成形术的可行性,详细介绍支气管新缝合技术“弯针直缝法”的临床应用.方法 2008年7月至2012年7月.江苏省肿瘤医院胸外科为7例支气管中心型非小细胞肺癌和1例左主支气管癌患者行全胸腔镜下肺癌切除及支气管成形术治疗.男5例,女3例；年龄48～73岁,平均(63.33 ±7.14)岁.5例全胸腔镜肺叶切除支气管楔形切除术,2例支气管袖状切除,1例左主支气管袖状切除±次级隆凸成形术.均采用王氏手术切口,在切除肿瘤及清扫纵隔淋巴结后,将传统缝合技术与“弯针直缝”新缝合技术相结合,完成8例全胸腔镜支气管成形术.结果 全组手术过程均顺利,未发生术中严重并发症、中转开胸情况.手术平均(2.53±1.92)h,出血量平均(110±80) ml,术后平均住院(11.3±1.4)天.远期随访均未发生支气管胸膜瘘等严重并发症.术后随访2～36个月,均恢复满意.结论 有丰富经验的胸腔镜外科医师行全胸腔镜支气管成形术治疗肺癌、主支气管癌是安全、可行的.“弯针直缝法”成功消灭了胸腔镜下复杂支气管吻合的缝合死角,简化了手术操作,缩短了手术时间,确实是一种简单实用,安全可靠的胸部微创缝合新方法.%Objective Investigating the feasibility of bronchoplasty in a complete video-assisted thoracic surgery (VATS) and introducing the clinical application of a novel technique,"sutura harmonia with a curve needle",for VATS bronchoplasty.Methods From July 2008 to July 2012,seven patients with central non-small-cell lung caner invading bronchi and one patient with left main bronchus (LMB) carcinoma accepted the tumor resection and bronchoplasty in complete VATS.The age of these patients ranged from 48 to 73 years old with an average age of(63.33 ± 7.14) years.There were 5 male patients and 3 female patients in our series.Five patients received the wedge resection of the tumor-invaded bronchi,two patients received the sleeve lobectomy,and the other one patient received LMB sleeve resection and secondary carinal reconstruction.Wang' s incisions were chosen as the surgical approach for all of these patients.After the resection of the tumors,traditional suture and our novel suturing technique,"sutura harmonia with a curve needle",were combined in the bronchoplasty of these eight patients.Results None of these patients suffered seriously intra-operative complications,such as bleeding and turning over to open thoracotomy.The average operation time was(2.53 ± 1.92) hours,the average volume of blood loss was(110 ±80) ml,and the average post-operative hospital day was(11.3 ± 1.4) days.Long-term following-up did not find any server complications like bronchopleural fistula.All the eight patients recovered well after 2 to 36 months following-up.Conclusion In terms of practical thoracoscope surgeons,complete VATS bronchoplasty was safe and feasible for treating central lung caner and even the main-stem bronchial carcinoma.Our new technique,"sutura harmonia with a curve needle",successfully eliminated the dead angles of a complicated anastomosis in complete VATS,simplified the operative procedures,and shortened the operative time.It is simple and safe of this novel suturing technique.