两孔法胸腔镜手术治疗原发性周围型肺癌的初步探讨  

Two-port Total Thoracoscopic Lobectomy for Primary Peripheral Lung Cancers:Preliminary Discussion

作　　者：雷霆[1] 李继良[1] 

机构地区：[1]大连医科大学附属第一医院胸外科,大连116011

出　　处：《中国微创外科杂志》2011年第12期1131-1133,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨两孔法电视辅助胸腔镜手术(VATS)治疗原发性周围型肺癌的手术操作方法和临床应用价值。方法 2009年10月～2011年2月,开展两孔法VATS治疗早期原发性周围型肺癌32例,腋中线第7肋骨上缘2.5～3 cm切口为观察孔兼副操作孔,腋前线第5肋骨上缘2.5 cm切口为主操作孔,均行肺叶切除加纵隔淋巴结廓清。右肺上叶8例,右肺中叶4例,右肺下叶7例,左肺上叶6例,左肺下叶7例。结果手术过程顺利,中转开胸1例(因转移淋巴结侵及肺动脉分离时出血),无严重手术并发症,无围手术期死亡。32例手术时间70～260 min,平均102 min。术中出血量50～300 ml,平均160 ml。每例清除淋巴结6～14枚,平均8.2枚。术后住院时间5～9 d,平均6.7 d。TNM分期:Ⅰa期7例,Ⅰb期7例,Ⅱa期10例,Ⅱb期5例,Ⅲa期3例。结论两孔法VATS治疗原发性周围型肺癌,手术操作方法安全、可靠,值得临床推广。Objective To study the operative skills and clinical value of two-port VATS for primary peripheral lung cancer. Methods Two-port VATS for lobeetomy was performed in 32 patients with early primary peripheial lung cancer from October 2009 to February 2011. With a 2.5-cm incision at the superior border of the 5th rib on the anterior axillary line as the main port, and a 2.5- to 3-cm incision at the superior border of the 7th rib on the middle axillary line as the observation port, we performed lobectomy and resection of the mediastinum lymph nodes. Lobeetomy was performed at the right upper lobe in 8 eases, right middle lobe 4 cases, right lower lobe 7 eases, left upper lobe 6 cases, and left lower lobe 7 cases. Results The procedure was finished in all the patients except for one who was converted to open surgery because the metastatic lymph nodes had invaded the pulmonary artery,which led to hemorrhage at separation. No severe complications nor perioperative death occurred. The mean operation time was 102 min （ranged from 70 -260 rain） , and the blood loss during the procedure ranged from 50 -300 ml with a mean of 160 ml. A mean of 8.2 lymph nodes were reseeted （6 - 14） in each patient. The postoperative hospital stay was 5 -9 days with a mean of 6.7 days. TNM staging： 7 cases at Ⅰ a , 7 at Ⅰ b, 10 at Ⅱ a, 5 at Ⅱ b, and 3 at Ⅲa. Conclusion Two-port VATS for lobectomy is safe, reliable and effective.

关 键 词：肺癌 肺叶切除术 两孔法 电视辅助 胸腔镜手术 

分 类 号：R734.2[医药卫生—肿瘤]