全胸腔镜支气管袖式成形肺癌切除的初步探讨  

Video-assisted Thoracoscopic Surgery Bronchial Sleeve Lobectomy for Lung Cancer:Report of Preliminary Experience

作　　者：刘伦旭[1] 梅建东[1] 蒲强[1] 马林[1] 朱云柯[1] 任福强[1] 车国卫[1] 张小龙[1] 

机构地区：[1]四川大学华西医院胸外科,成都610041

出　　处：《中国胸心血管外科临床杂志》2011年第5期387-389,共3页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨全胸腔镜支气管袖式成形术的可行性,并初步总结其手术方法,探讨其可行性。方法 2010年12月至2011年4月,四川大学华西医院胸外科在全胸腔镜下完成支气管袖式成形右上肺癌切除术3例(女1例、男2例,年龄分别为61岁、65岁和62岁),手术入路采用单向式胸腔镜肺叶切除术处理右肺上叶的手术切口。术中首先离断肺上静脉及上叶尖、前段动脉,打开叶间裂,清扫包括隆突下淋巴结在内的纵隔淋巴结,显露右主支气管后,经主操作孔切断支气管。以3-0Prolene线连续缝合吻合支气管。第3例患者在吻合时于腋后线第7肋间加作一0.5cm小孔,便于缝合时接针。吻合完毕后试水无漏气,以生物合成材料包裹吻合口。术后第1d行纤维支气管镜吸痰并检查吻合口情况。结果肺叶切除及淋巴结清扫时间51～58min(平均54.7min),支气管吻合时间40～55min(平均45.7min),术中出血量55～230ml(平均155.0ml),清扫淋巴结数量18～21枚(平均19.3枚)。3例患者中,2例为右肺上叶中央型鳞癌,1例为右肺上叶腺癌伴肺门转移淋巴结侵及上叶支气管起始部,病理检查显示断端均未见癌残留。3例患者术后均恢复良好,未出现围术期并发症,吻合口通畅。术后住院时间为8～10d(平均8.7d)。随访2～6个月,未出现手术相关并发症。结论对于具有熟练操作经验的胸腔镜外科医师,全胸腔镜支气管袖式成形术是安全、可行的。在单向式胸腔镜肺叶切除术切口的基础上,增加一个小操作孔,可使手术操作更为方便。Objective To investigate the feasibility of video-assisted thoracoscopic surgery（VATS） bronchial sleeve lobectomy for lung cancer, and to describe this treatment method.Methods Between December 2010 and April 2011,three patients in our hospital underwent VATS bronchial sleeve lobectomy as treatment for right upper lobe non-small cell lung cancer.The patients were one female and two males,aged 61,65,and 62 years.Surgical incisions were the same as for single-direction VATS right upper lobectomy.The right superior pulmonary vein was firstly transected,followed by the first branch of the pulmonary artery.Then,the lung fissure was transected and the mediastinal lymph nodes,including the subcarinal nodes,were also dissected to achieve sufficient exposure of the right main bronchus.The bronchus was transected via the utility incision,and the anastomosis was accomplished by continuous suture with 3-0 Prolene stitches.Another 0.5 cm port in the 7th intercostal space at the posterior axillary line was added in the third operation for handling of a pair of forceps to help hold the needle during anastomosis.A sealing test was performed to confirm that there was no leakage after completion of the anastomosis,and the stoma was covered with biological material.Bronchoscopy was performed to clear airway secretions and to confirm that there was no stenosis on postoperative day（POD） 1. Results The lobectomy and lymph node dissection was finished in 51-58 minutes（averaging 54.7）,and the time needed for anastomosis was 40-55 minutes（averaging 45.7）.Total blood loss was 55-230 ml（averaging 155.0 ml）.Number of dissected lymph nodes was 18-21（averaging 19.3）.One patient was diagnosed with adenocarcinoma of the right upper lobe with metastatic hilar lymph node invasive to the right upper lobar bronchus.The other two patients were both diagnosed with centrally located squamous cell carcinoma of the right upper lobe,and all the patients achieved microscopically negative margins.There was no stenosis of the anastom

关 键 词：肺肿瘤 胸腔镜 肺叶切除术 支气管袖式成形术 

分 类 号：R734.2[医药卫生—肿瘤]