胸腔镜肺叶切除术时中转开胸对患者的影响及其原因分析  

Effects and reasons of conversion during video-assisted thoracic surgery lobectomy

作　　者：杨博[1] 刘阳[1] 戴为民[1] 初向阳[1] 孙玉鹗[1] 王钰琦[1] 汪涛[1] 薛志强[1] 赵明[1] 

机构地区：[1]解放军总医院外科临床部胸外科,北京100853

出　　处：《中华医学杂志》2014年第47期3748-3750,共3页National Medical Journal of China

摘　　要：目的：评估胸腔镜肺叶切除手术时中转开胸对患者的影响，总结、分析中转开胸的原因，以降低中转开胸率。方法对2007年5月至2012年5月解放军总医院374例行胸腔镜下肺叶切除术患者的临床数据进行回顾性研究。按照是否中转开胸分为中转开胸组和胸腔镜组，比较两组患者的临床数据，并对中转开胸的原因进行分类总结。结果374例患者中36例中转开胸，中转开胸率为9．6％。中转开胸组和胸腔镜组中患者的年龄、性别及手术类型无明显差别，中转开胸组的手术时间较长，术中出血量较多，病理中良性疾病的比例较高，两组的术后并发症发生率、术后病死率、术后拔管时间及术后住院时间差异无统计学意义。中转开胸的原因分类为：血管损伤出血12例，致密粘连6例，器械相关5例，肺裂不全5例，解剖间隙不清3例，血管变异3例，切缘不足2例。结论中转开胸会延长胸腔镜肺叶切除术的手术时间，增加出血量，但对患者的术后恢复无明显影响。掌握常见中转开胸的原因及处理方法有助于降低中转开胸率。Objective To explore the impact and reasons of conversion during video-assisted thoracic surgery （ VATS） lobectomy.Methods A total of 374 patients undergoing VATS lobectomy during May 2007 and May 2012 were divided into 2 groups according to whether conversion was necessary.And their clinical data were retrospectively analyzed.Results Among them, 36 cases （ 9.6%） converted into thoractomy during VATS lobectomy.Their clinical profiles of age,gender and surgical type were similar.The conversion group had longer operative duration, more blood loss and more benign proportion than VATS group.No inter-group difference existed in postoperative complication, mortality; tube removal time or hospitalization length.The reasons of conversion included hemorrhage （n=12）,vascular adhesion （n=6）, instrumentation complication （ n =5 ） , incomplete fissure （ n =5 ） , uncertain anatomy （ n =3 ） , abnormal blood vessels （n=3） and insufficient margin （n=2）.Conclusion Conversion during VATS lobectomy may prolong operative duration and increase blood loss.However there is no effect upon patient recovery.

关 键 词：胸外科手术 电视辅助 肺切除术 肺肿瘤 

分 类 号：R655[医药卫生—外科学]