胸腔镜手术治疗叶内型肺隔离症  

Video-assisted thoracic surgery for intralobar pulmonary sequestration

作　　者：林宗武[1] 蒋伟[1] 王群[1] 葛棣[1] 谭黎杰[1] 徐松涛[1] 范虹[1] 卢春来[1] 

机构地区：[1]复旦大学附属中山医院胸外科,上海200032

出　　处：《中华胸心血管外科杂志》2012年第11期641-643,650,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的分析胸腔镜手术治疗叶内型肺隔离症的可行性、安全性及切除方法。方法回顾性分析2006年12月至2011年9月17例胸腔镜手术治疗的叶内型肺隔症患者资料，其中男性7例，女性10例；年龄14～61岁，平均40．3岁。术前通过增强CT确诊9例，未确诊8例。选择3孔切口，在下肺韧带内找到异常动脉后，使用直线型切割缝合器切断，然后根据情况选择肺楔形切除或者肺叶切除。结果17例胸腔镜手术均成功，无中转开胸，术后无严重并发症发生。5例患者选择行肺楔形切除，4例顺利完成，1例转肺叶切除；12例直接行肺叶切除。手术80～170min，平均128min；出血量5～200ml，平均80ml。术后胸管引流2～6天，平均4．0天；术后住院4～11天，平均7．6天。所有患者术中及术后病理均证实为叶内型肺隔离症。结论胸腔镜手术治疗叶内型肺隔离症安全可行，情况允许时，可以优先选择肺楔形切除或者肺段切除。Objective To analyze safety, efficacy and resection methods of video-assisted thoracic surgery（VATS） for the treatment of intralobar pulmonary sequestration（IPS）. Methods Data of 17 patients who were diagnosed as IPS and re- ceived VATS from December 2006 to September 2011 were retrospectively analyzed. The patients were 7 males and 10 females with the mean age of 40.3 （ 14 - 61 ） years. Diagnosis was confirmed in 9 patients by enhanced CT and unconfirmed in 8 pa- tients. Three ports were used for surgery. After the aberrant artery was confirmed, liner stapler was used in 16 patients to cut it and Hem-o-lok was used in 1 patient because the aberrant artery was about 3 mm in diameter and long enough. If the diame- ter of the aberrant artery was longer than 10 mm, a stapling device without knife was used to occlude it centrally and a second stapling device was used to cut it peripherally. Wedge resection or lobectomy was performed due to the different conditions. When the lesion was small with limited range in CT image and the lesion was easily distinguished from normal lung tissue during operation, wedge resection was preferred. Results Seventeen patients underwent VATS successfully without any conversion to thoracotomy or any serious complications. Five patients were planned to receive wedge resection and one was converted to lobec- tomy. Another 12 patients were planned to receive lobectomy and all succeeded. The mean operating time was 128 （80 - 170） min. The mean blood loss was 80 （5 - 200） ml. The mean days of chest tube maintained were 4.0 （2 - 6 ） days. The mean postoperative hospitalization days were 7.6 （4 - 11 ） days. All patients were diagnosed as IPS according to operating in-sight and postoperative pathology. There was no patient suffering from chronic cough, bloody sputum or recurrent pneumonia during the follow-up. Conclusion VATS for the treatment of IPS is safe and feasible. If conditions permit, wedge resection or seg- mentectomy may be preferred.

关 键 词：胸外科手术 电视辅助 肺隔离症 肺切除术 

分 类 号：R655.3[医药卫生—外科学]