全胸腔镜肺叶切除术中转开胸的临床研究

目的:探讨全胸腔镜肺叶切除术中转开胸的原因,以降低中转开胸发生率,准确把握中转开胸的手术指征。方法:2010年9月至2015年11月共完成胸腔镜肺叶切除术1 230例。手术均通过2~3个小切口完成,按照手术常规行解剖性肺叶切除及系统性淋巴清扫术。如镜下操作遇到血管损伤性出血、肺门淋巴结粘连或转移等腔镜下无法处理的情况,及时中转为开胸手术。根据术中是否中转开胸分为胸腔镜组与中转开胸组,对比两组患者的临床资料,分析引起中转开胸的相关原因及采取的相应措施。结果:患者手术顺利,无严重并发症发生及围手术期死亡病例。58例中转开胸,中转率4.7%,其中25例术中出血,23例淋巴结粘连或侵犯。56例开胸后顺利完成了肺叶切除,仅2例施行了全肺切除。两组手术时间、术中出血量、引流管放置时间、术后引流量、住院时间差异均有统计学意义(P0.05)。肺动脉损伤出血、淋巴结干扰是导致中转开胸最常见的原因。结论:肺动脉损伤、淋巴结干扰是中转开胸的主要原因,应根据术中具体情况及时准确地把握中转开胸的手术指征。

The causes and indications of conversion to thoracotomy in totally thoracoscopic lobectomy

Objective:To investigate the causes of conversion to thoracotomy in thoracoscopic lobectomy , so as to reduce the rate of thoracotomy and accurately grasp the opportunity of conversion to thoracotomy .Methods:Between Sep.2010 and Nov.2015, 1 230 patients underwent thoracoscopic lobectomy .Two or three incisions were made in all operations ,the procedures of anatomic lobec-tomy and systematic lymphadenectomy were similar with routine thoracotomy .If there was bleeding or lymph node at hilus of the lung adhesion,metastasis,the surgery would be converted to thoracotomy .The patients were divided into two groups based on whether thora-cotomy was performed .The data of both groups were compared respectively to analyze the reasons of conversion to thoracotomy and the befitting solutions .Results:All surgeries were carried out safely without serious complications or perioperative deaths .58 operations were converted to thoracotomy with a conversion rate of 4.7%.Among them,bleeding happened in 25 operations,and 23 were interfered by adhesive or invasive lymph nodes .Lobectomy was performed for 56 patients and pneumonectomy was performed on 2 patients.The differences of operative time ,intraoperative blood loss ,chest tube duration ,volume of chest tube drainage ,hospital stay between the two groups were statistically significant (P<0.05).The incidence of pulmonary artery injury and lymph node interference was higher than other factors which caused conversion to thoracotomy .Conclusions:Pulmonary artery injury and lymph nodes interference are the main causes of conversion to thoracotomy in totally thoracoscopic lobectomy .The indication for conversion to thoracotomy should be carefully and timely evaluated according to the intraoperative situation .