电视胸腔镜在肺癌手术治疗中的应用  

Surgical treatment of lung cancer by video-assisted thoracoscopic surgery

作　　者：刘伦旭[1] 周清华[1] 车国卫[1] 伍伫[1] 寇瑛利[1] 李定彪[1] 黄旭中[1] 赵雍凡[1] 石应康[1] 杨俊杰[1] 

机构地区：[1]四川大学华西医院胸心外科,成都610041

出　　处：《中国肺癌杂志》2004年第5期431-433,共3页Chinese Journal of Lung Cancer

摘　　要：目的　探讨电视胸腔镜在肺癌完全性及姑息性手术治疗中的作用。方法　 2 0 0 2年 2月至 2 0 0 3年 8月采用电视辅助胸腔镜手术 (VATS)治疗肺癌 43例。其中ⅠA期 5例 ,ⅠB期 14例 ,ⅡA期 1例 ,ⅡB期4例 ,ⅢA期 7例 ,T4 ⅢB期 6例 ,Ⅳ期 6例。ⅢA期术前临床评估为N0 ,术后病理查见N2 转移。ⅢB期病例中 3例为恶性胸水 ,3例为术中发现胸腔种植转移。Ⅳ期病例中 2例为晚期肺癌伴恶性心包积液 ,心脏压塞 ;1例为孤立脑转移瘤切除术后 ;3例为对侧或同侧肺孤立性转移。主要手术方式 :肺叶切除 3 6例 ,肺楔形切除5例 ,心包开窗 2例。其中 2例同期行对侧孤立性肺转移瘤楔形切除 ;恶性胸水行胸膜种植结节切除、烧灼 ,胸膜粘连术。行纵隔淋巴结清扫 3 6例。结果　无围术期死亡 ,无支气管胸膜瘘发生 ,肺部感染 5例 ,切口液化 2例。 3例恶性胸水均得到控制。 2例心包开窗引流患者分别于术后 4个月、8个月死亡。其余患者目前仍存活。除 2例心包开窗引流患者 ,外科术后住院时间为 5～ 15天 ,平均 7.4天。结论　VATS适合早期肺癌的完全性切除手术治疗 ,对偶然性N2 肺癌手术中行纵隔淋巴结清扫是可行的。对肺癌需同期双侧开胸手术者VATS具有显著优势。VATS对恶性胸水。Objective To investigate the role of curative and palliative surgical treatment of lung cancer with video-assisted thoracoscopic surgery (VATS). Methods Forty-three patients with lung cancer were prescribed operations with VATS, which included 5 cases of stage ⅠA, 14 cases of ⅠB, 1 case of ⅡA, 4 cases of ⅡB, 7 cases of ⅢA, 6 cases of T4-ⅢB and 6 cases of Ⅳ. The 7 patients of stage ⅢA were previously staged as N0 before operation, but reevaluated as N2-ⅢA after operation. There were 3 cases of malignant pleural effusion and 3 cases of pleural implantation in stage ⅢB cases. There were 2 cases of cardiac tamponade, 1 case of solitary brain metastasis, and 3 cases of ipsilateral or contralateral solitary lung metastasis in cases of stage Ⅳ. The main methods of operation performed included lobectomy in 36 cases, wedge resection in 5 cases, and pericardial opening in 2 cases. Systemly mediastinal lymph node dissections were performed in 36 cases. Concurrent contralateral pulmonary wedge resections were performed in 2 cases of contralateral solitary lung metastasis. Malignant pleural effusions were prescribed resection of implantation nodules, electrocautery and pleurodesis. Results There was no perioperative death or bronchial leak. Five cases suffered lung infection, and 2 cases occurred with incision infection. Malignant pleural effusion in the 3 cases was controlled satisfactorily. Two cases of pericardial opening died in 4 months and 8 months after operation respectively. The other patients were alive till present. Postoperative hospital stay was 5--15 days with average of 7.4 days, except of two cases of pericardial opening. Conclusion VATS is an alternative way for complete resection of early stage lung cancer. It is technically feasible to dissect mediastinal lymph node for accidental N2 lung cancer. VATS has significant advantage in concurrent bilateral pulmonary resection. The palliative operation of malignant pleural effusion and cardiac tamponade by VATS can markedly improve the qu

关 键 词：肺肿瘤 胸腔镜 VATS完全性切除 姑息性切除 

分 类 号：R734.2[医药卫生—肿瘤]