全胸腔镜下解剖性肺段切除41例临床分析  

Complete Video-assisted Thoracoscopic Anatomic Segmentectomy: Report of 41 Cases

作　　者：刘士学[1] 王君[2] 徐美清[2] 谢怀顺[1] 

机构地区：[1]安徽省淮南市第一人民医院胸外科,淮南232000 [2]安徽省立医院胸外科,合肥230000

出　　处：《中国微创外科杂志》2016年第12期1127-1130,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨全胸腔镜下肺段切除术的临床应用价值。方法回顾性分析2013年1月-2016年5月41例全胸腔镜下肺段切除术的临床资料,其中淮南市第一人民医院12例,安徽省立医院29例。三孔法,肺段动脉、静脉使用Hem-olok或直线型切割缝合器处理,肺段支气管及段间平面均使用直线型切割缝合器处理。结果 41例手术均顺利完成,无中转开胸及辅助小切口。手术时间89-208（121.0±15.5）min,术中出血量80-350（142.7±11.5）ml。21例原发肺癌行肺门纵隔淋巴结清扫,清扫淋巴结7-15（10.9±0.6）枚。无围手术期死亡。二次手术2例（1例术后咯血,1例肺不张）。术后胸腔引流时间5-9（7.8±0.2）d,术后住院时间6-14（9.3±0.4）d。术后病理诊断腺癌16例,鳞癌5例,转移癌3例,支气管扩张8例,炎性假瘤4例,结核球4例,血管畸形1例。对21例原发肺癌术后随访2-35（25.4±8.8）月,无复发、转移。结论全胸腔镜下解剖性肺段切除术安全、可行、有效。Objective To evaluate the clinical value of complete video-assisted thoracoscopic surgery（ VATS） anatomic segmentectomy. Methods Clinical data of 41 patients with lung diseases who underwent complete VATS segmentectomy in Anhui Provincial Hospital（ 29 cases） and Huainan First People＇s Hospital（ 12 cases） from January 2013 to May 2016 were retrospectively analyzed. The operation was performed with three-port method. The pulmonary artery and vein of the segment were dealt with Hem-olok or linear cutter stapler. The bronchi of the segment and intersegmental plane were dealt with staplers. Results All the 41 patients received complete VATS anatomic segmentectomy successfully without conversion to thoracoctomy or assisted small incision surgery. The operation time was 89- 208 min（ 121. 0 ± 15. 5 min）,and the intraoperative blood loss was 80- 350 ml（ 142. 7 ± 11. 5ml）. The number of lymph node dissection was 7- 15（ 10. 9 ± 0. 6） for 21 patients with lung cancer. There was no perioperative death. There were 2 cases of secondary operation,including 1 case of postoperative hemoptysis and 1 case of postoperative pulmonary atelectasis. Postoperative thoracic drainage time was 5- 9 days（ 7. 8 ± 0. 2 days）,and postoperative hospital stay was 6- 14 days（ 9. 3 ± 0. 4 days）. All the patients were discharged from hospital uneventfully. The postoperative pathological diagnosis showed adenocarcinoma in 16 cases,squamous cell carcinoma in 5 cases,metastatic carcinoma in 3 cases,bronchiectasis in 8 cases,inflammatory pseudotumor and tuberculoma in 4 respectively,and vascular malformation in 1. Lung cancer patients were followed up for 2- 35 months（ 25. 4 ± 8. 8 months） without recurrence or metastasis. Conclusion Complete VATS anatomic segmentectomy is safe,feasible and available with satisfying outcomes.

关 键 词：电视辅助胸腔镜手术 解剖 肺段切除术 

分 类 号：R734.2[医药卫生—肿瘤] R655.3[医药卫生—临床医学]