目的 通过对全胸腔镜(VATS)肺叶切除的临床资料进行分析,探讨VATS肺叶切除的安全性、有效性和适应证.方法 回顾性分析2006年9月至2009年7月期间连续完成的256例VATS肺叶切除病例,其中男140例,女116例;年龄18～86岁,平均(58.6 4±13.8)岁.对其一般资料,手术相关参数及术后随访结果等进行统计分析.结果 235例完成VATS肺叶切除,21例中转开胸(8.2%).235例VATS肺叶切除包括右肺上叶切除65例,右肺中叶31例,右肺下叶48例,左肺上叶56例,左肺下叶48例,联合肺叶7例,右全肺切除1例.手术时间60-490 min,平均(198.4±59.7)min;出血量20～1800ml,平均(267.2±253.5)ml;术后平均带管7.9d,平均住院11.0 d.手术时间、术中出血量、术后引流量良性病变好于恶性病变(P<0.05);钉仓使用数和术后住院天数二者相似.中转开胸主要原因为淋巴结粘连12例,术中出血5例,肿瘤过大或炎性粘连4例.术后病理包括非小细胞肺癌(NSCLC)178例,肺转移瘤7例,类癌5例,神经内分泌癌2例,其他恶性肿瘤7例;肺部良性疾病57例.全组无围手术期死亡,3级以上并发症27例.178例NSCLC术后Ⅰ期126例,Ⅱ期17例,Ⅲ期32例,Ⅳ期3例.随访l一34个月显示NSCLC术后1年、2年生存率在Ⅰ/Ⅱ期为98.5%、96.3%,Ⅲ/Ⅳ期为91.7%、83.3%.结论 VATS肺叶切除术是治疗肺部良性疾病及早期肺癌上的一种安全有效术式.%Objective Video-assisted thoracic surgery (VATS) lobectomy has been proven to be safe and technically feasible, but is not a routine procedure in most hospitals in China. The aim of this study is to introduce skill of VATS lobectomy and our experiences and outcomes. Methods The data of VATS lobectomy between September 2006 and July 2009 in a single hospital were retrospective reviewed. Demographic, histopathologic, perioperative status, and outcome were assessed using standard descriptive statistics and Kaplan-Meier survival analyses. A total of 256 VATS lobectomies were performed. There were 110 females and 140 males, with a mean age of 58.6(range 18-86)years. Results Thoracoscopic lobectomy was successfully performed in 235 patients, 21 patients (8. 2% ) were converted to a thoracotomy mainly due to lymphadenopathy (n = 12) and bleeding (n=5). Postoperative pathology included 178 non-small cell lung cancer (NSCLC), 21 other malignancy and 57 benign lesions. Among thel78 patients with NSCLC, 126 patients were stage Ⅰ , 17 stage Ⅱ , and 35 stage Ⅲ or. stage Ⅳ. The mean operative time was 198 mins (range 60 to 490 mins). The mean blood loss was 267 ml ( range 20 to 1800 ml). The median chest tube duration was 7.9 days and the median length of hospitalization was 11.0 days. There was no perioperative (30-day) mortality. Postoperative complication rate was 10. 2%. The overall 2-year survival rate for the stage Ⅰ/Ⅱ and stage Ⅲ/Ⅳ were 96.3% and 83.3% , respectively. Conclusion Thoracoscopic lobectomy is applicable to a spectrum of malignant and benign pulmonary disease and is associated with a low perioperative morbidity and mortality rate. Survival rates are comparable to lobectomy through thoracotomy.
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