全电视胸腔镜下肺叶切除35例分析

摘要

目的 探讨全电视胸腔镜(video-assisted thoraeic surgery,VATS)手术行肺叶切除的安全性和对早期肺癌的疗效.方法 连续完成全电视胸腔镜肺叶切除35例,其中原发周围性肺癌28例,良性肿瘤7例.胸腔镜观察孔位于腋中线第7肋间,第一操作孔(主操作孔)位于腋前第3肋间2.5-3cm(上、中叶)或第4肋间(下叶)、第二操作孔肩胛线与腋后线之间第9肋间1.5～2 cm;不用胸撑开器.施行右肺上叶切除10例,右肺中叶切除2例,右肺下叶切除5例,左肺上叶切除10例,左肺下叶切除8例.恶性肿瘤同时施行标准淋巴结清扫.结果 并发右下肺炎1例,右肺中叶肺不张1例,均经保守治疗而痊愈.无二次手术,无围手术期死亡.随访1～15个月,1例术后12个月发生远处转移.结论 全电视胸腔镜手术治疗早期肺癌早期疗效肯定,行肺叶切除手术创伤小、术中出血少、术后疼痛轻、恢复快、安全.%Objective To explore the effect of whole video-assisted thoracoscopic (video-assisted thoraeic surgery, VATS) on lobectomy surgery of early lung cancer. Methods All consecutive complete VATS lobectomy made the Central Plains around 35 cases of lung cancer in 28 cases ,benign tumors in 7 cases. Thoracoscopic observation hole in the 7th intercostal space midaxillary line, the first operation hole (the primary operating hole) is located in the former No. 3 axillary intercostal 2. 5 -3cm (last, middle) or 4 intercostal (lower lobe), the second operation hole scapular line and the posterior axillary line between the 9th intercostal 1. 5 -2 cm; without chest distraction device. Implementation of right upper lobe resection in 10 patients, right middle lobe resection in 2 cases, 5 cases of right lower lobe, left upper lobe resection in 10 cases, 8 cases of left lower lobe. Implementation of standards for malignant lymph nodes at the same time. Results 1 case of pneumonia complicated by right lower, right middle lobe atelectasis in 1 case, were cured by conservative treatment. No second surgery, no perioperative deaths. Follow-up 1-15 months, 1 TIN 2M 0 after 12 months of distant metastasis. Conclusion VATS lobectomy patients with early lung cancer, surgical trauma, less blood loss, postoperative pain, quick recovery, security.