电视胸腔镜辅助小切口肺叶切除术63例报告

目的探讨电视胸腔镜（video—assisted thoracoscopic surgery，VATS）辅助小切口肺叶切除术在肺部疾病和非小细胞肺癌治疗中的适应证、安全性。方法1996年5月～2007年4月，VATS辅助小切口行肺叶切除术63例，其中术前诊断肺良性病变18例，肺实质性占位或恶性病变45例，行右肺上叶切除术12例，右肺中叶切除8例，右肺下叶切除27例，左肺上叶切除5例，左肺下叶切除11例。结果63例均成功行胸腔镜肺叶切除术（其中延长切口6例）。无围手术死亡。胸腔闭式引流时间4～7d，平均4．5d。术后病理诊断：原发性非小细胞肺癌（NSCLC）37例（58．7％），转移癌1例（1．6％），类癌1例（1．6％）；良性病变24例（38．1％）。37例NSCLC中术后病理临床分期：Ⅰa期8例，Ⅰb期13例，Ⅱa期4例，Ⅱb期3例，Ⅲa期6例，Ⅲb期1例，Ⅳ期2例。恶性肿瘤随访34例（87．2％），其中2～12个月7例，13～24个月10例，25～36个月6例，37～48个月6例，49～60个月3例，2例生存11年。因肿瘤复发或转移死亡5例（14．7％），带瘤生存1例（2．9％），无瘤生存28例（82．4％）。Ⅰ、Ⅱ期肺癌1年和3年生存率为100％（19／19）、90％（9／10）；Ⅲ期肺癌随访5例，3例死于肿瘤复发或转移；Ⅳ期2例中1例死于转移。结论VATS辅助小切口肺叶切除术安全，可达到彻底切除目的，其适应证为肺良性疾病和Ⅰ、Ⅱ期周边型非小细胞肺癌，可作为其常规手术之一。

Video-assisted Thoracoscopic Lobectomy with Small Auxiliary Incision: Report of 63 Cases

Objective To explore the indications and safety of video-assisted thoracoscopic lobectomy with small auxiliary incision for benign pulmonary diseases and non-small cell lung cancer. Methods Between May 1996 and April 2007, 63 cases of lobectomy were performed by video-assisted thoracoscopy. Before the operation, 18 of the patients were diagnosed with benign pulmonary diseases, and 45 had pulmonary mass or malignancies. Lobectomy of the right lung was carried out on 47 patients, including the right upper lobe resection in 12, the middle lobe in 8, and the lower in 27. The other 16 patients received resection of the left upper lobe （5） or left lower lobe （11 ）. Results Thoracoscopic lobectomy was completed in all the 63 patients, in 6 of them the incision was lengthened during the operation. No perioperative death occurred. The chest tube was withdrawn 4 to 7 days （ mean, 4.5 days） after the operation. Postoperative pathological examination showed NSCLC in 37 patients （58.7%） , metastatic lung cancer in 1 （ 1.6% ） , carcinoid tumor in 1 （ 1.6% ） , and benign conditions in 24 （ 38.1% ）. Among the 37 patients with NSCLC, 8 were at stage Ⅰa, 13 at stage Ⅰ b, 14 at stage Ⅱa , 3 at stage Ⅱb, 6 at stage Ⅲa, 1 at stageⅢb, and 2 at stage IV. Of the patients with malignancies, 34 were followed up for 2 to 60 months （2 to 12 months in 7, 13 to 24 months in 10, 25 to 36 months in 6, 37 to 48 months in 6, and 49 to 60 months in 3） , 2 of them survived 11 years,5 of the patients （ 14.7% ） died of tumor recurrence or metastasis, 1 （2.9%） survived with tumor, and 28 （82.4%） lived free of tumor. The 1- and 3-year survival rate of the patients with stage Ⅰ or Ⅱ cancer were 100% （19/19） and 90% （9/10） respectively. In the patients with stage Ⅲ cancer, 5 received follow-up, 3 of them died of recurrence of metastasis. In the 2 patients who had stage IV cancer, 1 died of metastasis. Conclusion Videoassisted thoracoscopic lobectomy is a safe and effective procedure a