全胸腔镜肺叶切除术治疗支气管扩张症

摘要

Objective To summarize the surgical skills and the intra-operative treatment of complete video-assisted thoracoscopic surgery ( cVATS ) for lobectomy in the management of bronchiectasis .Methods Between September 2011 and February 2014, a total of 19 patients (13 female and 6 male, aged 26 to 68 years with a mean of 51.9) underwent VATS for lobectomy in our center .Then, operation time, intra-operative blood loss, postoperative thoracic drainage , complications and hospitalization were reviewed retrospectively .Results cVATS lobeetomy was successfully performed in 17 patients .Conversion to open surgery occurred in 2 patients due to severe adhesion at the hilus .The mean operation time was (126.3 ±42.1) min, blood loss was (194.7 ± 90.5) ml, postoperative drainage was (6.4 ±3.8) d, and the mean postoperative hospital stay was (9.5 ±7.7) d.There was no hospital death or major morbidity .Postoperative pathological examination confirmed the diagnosis of bronchiectagis in all of the patients .No serious complications were noticed during a mean follow-up of 6 months.17 patients (90%) relieved symptoms completely, 2 patients (10%) were improved with markedly decreased volume of sputum .Conclusions Chronic innammation induced adhesions is the key limiting factor for thoracoscopic lobectomy for bronchiectasis .It is of importance to recognize the scope of the operation , identify the indications for conversion to a thoracotomy and perform a non-single-order operation .%目的：探讨全胸腔镜下（ VATS）肺叶切除术治疗支气管扩张症的手术技巧和术中经验。方法以2011年9月至2014年2月我科经全胸腔镜下肺叶切除术治疗支气管扩张症的19例临床资料为对象，对手术完成情况、手术时间、出血量、术后胸腔引流时间、并发症和预后情况做回顾性分析。结果全组中2例因为胸腔内或肺门处严重粘连出血，镜下处理困难而中转开胸行VATS辅助小切口手术。余17例在全胸腔镜下完成。手术时间（126．3±42．1）min，出血量（194．7±90．5）ml，术后胸腔引流带管时间（6．4±3．8）天，术后住院时间（9．5±7．7）天。术后病理均符合支气管扩张症改变。无围手术期死亡及严重并发症。全组患者出院后均随访6个月，17例（90％）术后咳痰或咯血症状完全消失，2例（10％）有间断咳痰症状。结论炎症粘连是支气管扩张症应用胸腔镜肺叶切除手术治疗的主要障碍。采用非单一手术程序，不苛求解剖性切除，正确把握中转开胸手术的指征，全胸腔镜肺叶切除手术治疗支气管扩张症是安全、可行的。