全胸腔镜解剖性肺段切除术12例报告  

Total Thoracoscopic Anatomic Pulmonary Segmentectomy: a Report of 12 Cases

作　　者：蔡海波[1] 李迎新[1] 张士法[1] 高连方[1] 周广华[1] 

机构地区：[1]山东省济宁市第一人民医院胸外科,济宁272111

出　　处：《中国微创外科杂志》2014年第2期155-157,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的 探讨全胸腔镜肺段切除术的可行性、安全性及手术适应证.方法 2011年3月～2013年3月我院行胸腔镜解剖性肺段切除术12例,采用标准完全胸腔镜肺叶切除切口,按照解剖学依次用钉高2.5 mm 白色钉仓处理肺段动脉、肺段静脉,用钉高3.5 mm 蓝色钉仓处理支气管,同时进行系统淋巴结清扫.结果 12例均顺利完成胸腔镜解剖性肺段切除术,无中转开胸及辅助小切口.手术时间115～260 min,平均182 min;术中出血量100～300 ml,平均230 ml.胸腔引流时间2～6 d,平均3.5 d.术后住院3～11 d,平均7.5 d.无二次手术,无输血,无围手术期死亡.术后病理：腺癌6例,鳞癌2例,转移癌2例,炎性假瘤1例,结核球1例,其中原发非小细胞肺癌均为Ⅰa期.12例随访1～24个月,平均9个月,10例肺癌均无复发、转移.结论 全胸腔镜解剖性肺段切除术对于Ⅰa 期非小细胞肺癌及肺功能差或有其他合并症而不适合行肺叶切除者,是一种安全可行的选择.Objective To investigate the safety, efficacy and indications of total thoracoscopic pulmonary segmentectomy. Methods Twelve patients underwent total thoraeoscopic anatomic pulmonary segmenteetomy from March 2011 to March 2013 in our hospital. Standard incision of thoraeoscopic lobectomy was made in the procedure. Along with systemic lymphadenectomy, the pulmonary segmental artery and vein were managed respectively with ENDO RLC 4525L, and the bronchi with ENDO RLC 4535L. Results All the 12 patients underwent total thoraeoseopic anatomic segmenteetomy successfully without conversion to thoraeoetomy or assisted small incision. Operation time was 115 -260 min （average, 182 min） ; intraoperative blood loss was 100 -300 ml （average, 230 ml） ; thoracic drainage time was 2 - 6 d （ average, 3.5 d） ; postoperative hospital stay was 3 - 11 d （ average, 7.5 d）. There was no secondary operation, blood transfusion or perioperative death in the procedure. Postoperative pathological examination showed adenocareinoma in 6 eases, squamous cell carcinoma in 2, metastatic carcinoma in 2, inflammatory pseudotumor and tuberculoma in 1 respectively, and the primary non-small cell lung cancer was classified as stage I a. The 12 cases were followed up for 1 - 24 months, with an average of 9 months and no recurrence or metastasis was found in the 10 cases of pulmonary cancer. Conclusion Total thoracoscopic anatomic pulmonary segmentectomy is safe and feasible for stage I a non-small cell lung cancer and patients with poor pulmonary function or complicated with other diseases.

关 键 词：胸腔镜 肺段切除术 肺癌 

分 类 号：R734.2[医药卫生—肿瘤]