小切口电视胸腔镜辅助与传统开胸肺癌根治术的比较  

Mini-incision video-assisted thoracoscopic versus conventional surgery for lung cancer

作　　者：常建华[1] 游庆军[1] 翁鸢[1] 蔡铭[1] 常庆[1] 

机构地区：[1]苏州大学附属第四医院胸心外科,无锡214062

出　　处：《中国微创外科杂志》2007年第5期412-414,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨小切口电视胸腔镜辅助肺癌根治术的临床价值。方法2005年1月～2006年6月收治49例I、Ⅱ期非小细胞肺癌,22例在小切口(腋前线肋间6～8cm)辅助电视胸腔镜下行肺叶切除术及肺门纵隔淋巴结清扫(VATS组),27例在常规开胸手术下完成肺叶切除术及淋巴结清扫(传统开胸组),比较2种术式肺功能和C反应蛋白(C reactiveprotein,CRP)的变化。结果胸腔镜组2例为方便安全地处理肺门血管将小切口扩大至12～15cm。2组患者术后血清CRP浓度明显升高,第1天达到峰值,胸腔镜组CRP术后1d(56.1±10.9)mg/L,显著低于传统开胸组(73.8±15.1)mg/L(t=-4.603,P=0.000)。2组术后肺功能每分钟通气量相对值(minute ventilation volume,MV)、1秒用力呼气容积相对值(forced expiratory volume in one second,FEV1)下降,术后1周时胸腔镜组MV为(95.6±16.4)L,显著高于传统开胸组(81.9±12.7)L(t=3.296,P=0.002),胸腔镜组FEV1为(57.1±5.7)%,显著高于传统开胸组(51.4±6.9)%(t=3.105,P=0.003)。结论与常规开胸肺癌根治术相比,小切口电视胸腔镜辅助肺叶切除术适合于早中期肺癌,疗效确切,可明显减少病人的手术创伤,可以作为非小细胞型肺癌的一种常规的治疗手段。Objective To investigate the clinical value of video-assisted thoracoscopic surgery （VATS） in the treatment of lung cancer. Methods The study included 49 patients with non-small cell lung cancer at stage Ⅰ - Ⅱ from January 2005 to June 2006. Lobectomy with mediastinal lymph node resection was performed by using VATS in 22 patients （Thoracoscopic Group） and by using conventional surgery in 27 patients （ Conventional Group）. The pulmonary functions and levels of C-reactive protein （CRP） were compared between the two groups. Results In the Thoracoscopic Group, a conversion to thoracotomy （ 12 - 15 cm of incision length） was required in 2 patients for treating blood vessels safely. The concentrations of CRP rose to the highest on the first day in both of groups. As compared with the Conventional Group, the CRP levels were significantly lower in the Thoracoscopic Group on the first day （56. 1 ± 10.9 mg/L vs 73.8 ±15.1 mg/L; t = - 4. 603, P = 0. 000）. At 1 week after operation, the Thoracoscopic Group presented significantly lower minute ventilation volume （MV） （95.6 ± 16.4 L vs 81.9 ± 12.7 L; t = 3. 296, P = 0. 002） and forced expiratory volume in one second （ FEV1 % ） （ 51.7 ± 5.7 % vs 51.4 ±6.9% ; t = 3. 105, P = 0. 003 ） than the Conventional Group. Conclusions VATS can be routinely adopted in patients with lung cancer at stage Ⅰ or Ⅱ , with lesion 〈 4 cm in diameter and without mediastinal lymph node metastasis.

关 键 词：电视辅助胸腔镜 肺叶切除 非小细胞肺癌 

分 类 号：R734.2[医药卫生—肿瘤]