向中国介绍电视胸腔镜肺叶切除术及如何避免西方的失误

目的在过去10～15年里，香港、日本和西方的临床医生开展了非小细胞肺癌的电视胸腔镜肺叶切除手术。虽然此种技术的支持者发表了结果满意的文章，但毫无疑问有些病人遭受了由于医生的技术尚处于学习曲线阶段或由于病例选择不当造成的失误。杂志投稿零星的报道和在国际会议上的个人交流并未被广泛传播，而且外科医生不太可能发表效果不好的结果，这些都导致报道的阳性误差。尽管我们中心已经有650例胸腔镜手术的经验，其中还包括食管切除、扩大胸腺切除、膈肌修补等复杂手术，但我们对开展非小细胞肺癌胸腔镜肺叶切除术仍很谨慎，因为我们不希望危及开胸手术的良好效果。另外，为了向中国医生全面系统地介绍这一经过慎重考虑的技术，对于将要开展胸腔镜肺叶切除术的医院，我们推荐了一个10步方案。本文还将介绍我们中心开展胸腔镜肺叶切除的经历，在过去12个月中技术的提高呈指数级增长，学习曲线达到平台期。本文详细介绍电视胸腔镜肺叶切除术，40例手术无死亡，5年生存率86％。根据现有的证据，在中国目前正在继续进行医疗改革之际，对合适的非小细胞肺癌进行胸腔镜手术应会使广大的人群获益。

Delivering VATS Lobectomy to the People of China Without the Mistakes of the West

Objective Over the last 10-15 years,groups from Hong Kong,Japan and the West have developed programs of VATS lobectomy for NSCLC.Despite favourable reports in the literature from proponents of the procedure,there have undoubtedly been patients who have suffered from mistakes made during the technical learning curve or as a result of poor patient selection.Isolated reports in letters to editors and personal communications at international conferences are not widely disseminated,and a surgeon with poor results is unlikely to publish his series,resulting in positive reporting bias.Despite our unit having experience with over 650 VATS procedures including complex operations such as oesophagectomy,radical thymectomy and diaphragm repair,we were cautious in the uptake of VATS lobectomy for NSCLC,as we did not wish to jeopardise our good results from open surgery.In addition to advising a cautious and considered approach to the wholesale introduction of this technology into China,a 10-step plan is presented for units considering introducing VATS lobectomy.The journey to VATS lobectomy for the author's centre is also presented,with an exponential rise in the technique in the last 12 months as the learning curve has reached its plateau.The author's technique is described in detail.In a small series of 40 patients,there was no operative mortality and 5-year survival was 86%.Based on the evidence to date,the proper introduction of this technology for NSCLC could have a dramatic population-based benefit as China continues its latest(medical) revolution.