胸腔镜手术在老年肺部肿瘤患者中的临床应用  

Clinical Application of Thoracoscopic Surgery in Elderly Lung Cancer Patients

作　　者：陈瑞彬[1] 郭刚[1] 陈楠[2] 王巍炜[2] 张继朋[1] 李高峰[2] 

机构地区：[1]昆明医学院第三附属医院胸外科,云南昆明650000 [2]云南省肿瘤医院胸外科,云南昆明650000

出　　处：《昆明医学院学报》2012年第2期64-67,共4页Journal of Kunming Medical College

基　　金：云南省社会发展基金资助项目(2010CA015);云南省科技厅联合基金资助项目(2010CD185)

摘　　要：目的总结用电视胸腔镜手术(VATS)诊治老年(≥65岁)肺癌的经验.方法对昆明医学院第三附属医院胸外科同期住院72例老年肺癌患者采取随机分组,36例老年肺癌患者行VATS为治疗组,其中行肺叶楔形切除术20例,肺叶根治术11例,中转开胸者5例,术中送冰冻快速病理检查,并行淋巴结系统性清扫;另外36例采用传统开胸手术为对照组.结果治疗组肿瘤均完整切除,术后病理报告切缘未见癌细胞;全组无围手术期死亡,术后未出现严重并发症.其中右胸清扫淋巴结(12.5±1.4)个,左胸清扫淋巴结(10.5±0.5)个.VATS时间35～114 min,平均(77±13)min.比开胸组短(P<0.05).术后平均住院时间(5.9±2.5)d比开胸组短(P<0.05),术后引流管留置时间(3.4±1.6),比开胸组短(P<0.05).其中1名有心脏病史患者于ICU入住3 d,无患者围手术期死亡.结论 VATS对老年患者较传统开胸手术创伤小、并发症少、生理干扰小,术后恢复快,特别对伴有心肺等慢性病患者较安全.Objective To summarize the experience in the treatment of elderly patients（65 years of age）with lung cancer by using video-assisted thoracic surgery（VATS）.Methods 72 elderly patients with lung cancer were enrolled in this study.36 cases of lung cancer in elderly patients were treated with VATS,including lung wedge resection in 20 cases,lung resection in 11 cases,transit thoracotomy in 5 cases,the intraoperative frozen tissues were given fast pathological examination,and systematic lymph node dissection was performed in parallel.Another 36 patients were given traditional surgery.Results All patients got complete tumor resection,the postoperative pathology report showed no cancer cells in the incisal margin of tumors.There were no perioperative deaths and no serious postoperative complications（12.5±1.4）right chest lymph nodes and（10.5 ±0.5）left chest lymph nodes were dissected,respectively.The time of VATS was 35 ~ 114 min,mean（77±13）min.Mean postoperative hospital stay time was（5.9±2.5）d,drainage tube indwelling time was（3.4±1.6）d.One patients with a history of heart disease stayed in ICU for 3 days.Conclusion Comapred with traditional thoracotomy,VATS for thoracic surgery in elderly patients has minimal invasion,fewer complications,little physical interference,rapid postoperative recovery,and is safer especially for patients with chronic heart and lung diseases.

关 键 词：胸腔镜 老年肺癌 

分 类 号：R655.3[医药卫生—外科学]