全胸腔镜下肺叶切除手术中转开胸原因分析

目的分析全胸腔镜肺叶切除术中转开胸的原因，以更好地把握全胸腔镜手术适应证及中转开胸的时机。方法回顾性分析2007年10月至2013年4月在江苏省肿瘤医院胸外科进行的全胸腔镜下肺叶切除术共1432例，其中98例中转开胸。结果中转开胸率为6．84％，实体肿瘤平均直径为37．4mm（5～70mm）。平均手术时间215min，术中平均出血量550mL。中转开胸原因包括：血管损伤（占36．8％），淋巴结干扰（占26．5％），致密粘连（占21．4％），其他原因（占15．3％）。结论血管损伤出血和淋巴结干扰是主要的中转开胸的原因。

The causes of conversion to thoracotomy in completely thoracoscopic lobectomy

Objectlve To analyze the causes of conversion to thoracotomy in completely thoracoscopic lo- bectomy, find out the best time and investigate the indications for conversion to thoracotomy in completely thoracoscopic lobectomy. Methods A total of 1 432 cases of thoracoscopic lobectomy in Jiangsu Province Tumor Hospital of Thoracic Surgery department were retrospective analyzed from October 2007 to April 2013, of twhich 98 cases were converted to thoracotomy. Results The conversion rate was 6.84%, and the average tumor di- mension was 37.4mm. The average surgical duration was 215 minutes, and the average blood loss was 550 ml. The causes of conversion to thoracotomy in completely thoracoscopic lobectomy include vascular injury （36.8%） , interference by lymph nodes （26.5%） , dense adhesions （21.4%） and others （ 15.3% ）. Conclusions Vascular injury and interference by lymph nodes are the most important causes of conversion to thoracotomy in completely thoracoseopic lobectomy.