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全胸腔镜下肺叶切除技术要点分析
引用本文:李剑锋,李运,王俊,刘军,姜冠潮,赵辉,杨帆,刘彦国,周足力,卜梁.全胸腔镜下肺叶切除技术要点分析[J].中国微创外科杂志,2009,9(1):30-32.
作者姓名:李剑锋  李运  王俊  刘军  姜冠潮  赵辉  杨帆  刘彦国  周足力  卜梁
作者单位:北京大学人民医院胸外科胸部微创中心,北京,100044
摘    要:目的探讨全胸腔镜下肺叶切除的技术难点及对策。方法2006年9月~2008年5月,施行全胸腔镜下肺叶切除91例。通过胸部3个微小切口非直视下完成肺叶解剖性切除及淋巴结清扫,方法与常规开胸手术相同。施行右肺上叶切除21例,右肺中叶切除12例,右肺下叶切除20例,左肺上叶切除18例,左肺下叶切除20例。结果中转开胸2例。全胸腔镜下完成的89例手术时间(185.8±52.9)min(60~300min);术中出血量50~650ml,平均213.2ml;胸腔引流时间(6.9±2.9)d;术后住院(9.4±3.2)d。乳糜胸1例,无严重并发症及围术期死亡。随访原发肺癌中2例分别于术后15、3个月发生远处转移,其余患者无复发、转移。结论全胸腔镜下肺叶切除手术是一种安全有效的手术方式,但是需要把握适应证并熟练掌握处理血管和清扫淋巴结等关键技术。

关 键 词:胸腔镜  肺叶切除术  淋巴结  乳糜胸

Strategies for Completely Thoracoscopic Lobectomy
Li Jianfeng,Li Yun,Wang Jun,et al..Strategies for Completely Thoracoscopic Lobectomy[J].Chinese Journal of Minimally Invasive Surgery,2009,9(1):30-32.
Authors:Li Jianfeng  Li Yun  Wang Jun  
Institution:Li Jianfeng,Li Yun,Wang Jun,et al.Department of Thoracic Surgery,Peking University Renmin Hospital,Beijing 100044,China
Abstract:Objective To discuss the technical strategies for thoracoscopic lobectomy. Methods Between September 2006 and May 2008, a total of 91 patients underwent thoracoscopic lobectomy in our hospital. The lobectomy and lymph node resection were completed via three mini incisions with the same procedures as those in an open surgery. Among the cases, 75 had primary or metastatic malignancies, and 16 showed benign tumor. By thoracoscopy, upper right lobectomy was carried out in 21 patients, right middle lobectomy in 12, lower right in 20, upper left in 18, and lower left in 20. Results Only two cases were converted to open thoracotomy. In the other 89 patients, the mean operation time for the thoracoscopy was ( 185.8 ± 52.9) minutes ( ragne,60 - 300 minutes) , and the mean blood loss was 213.2 ml (range,50 -650 ml). In this series, the chest drainage lasted (6.9 ±2.9) days; the patients were discharged from the hospital in (9.4 ± 3.2) days after the surgery. No severe complications or perioperative death occurred in the cases except in one patient, who developed chylothorax after the treatment. Two patients, who had primary lung cancer, showed distant metastasis at 15 and 3 months respectively after the surgery. No recurrence or metastasis was found in the other cases. Conclusions Thoracoscopic lobectomy is safe and effective for patients with indications for the surgical procedure. Surgical skills for dissection of vessels and lymph nodes are the key to the operation.
Keywords:Thoracoscopy  Lobectomy
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