电视胸腔镜手术在肺恶性肿瘤合并气胸诊断和治疗中的应用  

Treatment and Diagnosis of Malignant Lung Cancer Complicated with Pneumothorax with Video-assisted Thoracoscope

作　　者：张翔宇[1] 张凯[1] 赵桂彬[1] 李吉尧[1] 闫宇博[1] 崔键[1] 

机构地区：[1]哈尔滨医科大学第四临床医学院胸外科,哈尔滨150001

出　　处：《中国微创外科杂志》2011年第8期704-705,717,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)对肺恶性肿瘤合并气胸的诊断和治疗价值。方法 2002年4月～2008年5月,19例术前胸部CT提示单侧周围型肺肿瘤合并气胸,术前均无明确病理诊断,行VATS手术探查,术中取肺肿瘤组织快速冰冻切片,根据病理结果和病人情况决定手术方式,同时处理肺脏漏气部位。结果全胸腔镜肺肿瘤楔形切除10例,胸腔镜辅助小切口手术9例(其中原发肺癌根治4例,肺肿瘤射频消融5例)。14例肺转移瘤均行胸膜摩擦固定。均手术顺利,均明确病理诊断。手术时间45～90 min(平均51.4 min),术中出血量50～280 ml(平均150 ml),胸管引流时间3～8 d(平均4.5 d)。术后2例轻度漏气,无特殊处理自愈,无围手术期死亡。术后所有患者肺复张良好。19例术后随访2～49个月,平均23个月,仅1例气胸复发,行胸腔闭式引流治愈。结论 VATS对明确周围型肺肿瘤病理诊断有重要作用,同时及时有效治疗气胸和肺恶性肿瘤,值得推荐。Objective To discuss the value of video-assisted thoracoscopic surgery（VATS） for the diagnosis and treatment of malignant lung tumor complicated with spontaneous pneumothorax.Methods From April 2002 to May 2008,19 patients whose CT examination showed unilateral peripheral lung tumor associated with spontaneous pneumothorax without definite pathological diagnosis,underwent VATS in our hospital.The scope and procedure of the surgery was determined during the operation according to frozen pathology and patient＇s condition.The leaking sites of the lung were repaired at the same time.Results Wedge resection by total thoracoscopy was completed in 10 cases,and thoracoscopic-assisted small incision surgery was performed in 9 patients（including totally resection of primary lung cancer in 4 patients,and radio frequency in 5）.14 patients who had lung metastases received pleural friction fixation.The mean operation time in the patients was 51.4 min（ranged from 45 to 90 min）,and intraoperative blood loss was 150 ml（50-280 ml）.Chest drainage was withdrawn in 3 to 8 days with a mean of 4.5 days;two patients showed mild leakage after that but was cured spontaneously.No patient died in perioperative stage,all the patients showed lung reexpansion well.The 19 patients received a follow-up for 2 to 49 months（mean,23 months）,only one of them had recurrent pneumothorax,who was then cured by closed chest drainage.Conclusion VATS plays a key role in clarifying the pathology of peripheral lung tumor and treating effectively pneumothorax and lung malignant tumor.

关 键 词：电视胸腔镜手术 肺肿瘤 自发性气胸 

分 类 号：R734.2[医药卫生—肿瘤] R561.4[医药卫生—临床医学]