全胸腔镜肺叶切除术扶镜技术探讨

目的：探讨全胸腔镜下肺叶切除手术的扶镜技术。方法回顾性分析2008年10月-2012年10月我院100例肺部疾病患者行全胸腔镜肺叶切除术的临床资料，施行右肺上叶切除23例，右肺中叶切除7例，右下肺叶切除26例，右中、下肺叶切除2例，左上肺叶切除15例，左下肺叶切除27例。所有患者均在全电视胸腔镜下行肺叶切除术。手术通过3个胸部微创切口，不撑开肋骨，在胸腔镜监视下，完成解剖性肺叶切除；恶性肿瘤患者同时行淋巴结清扫。结果97例手术获得成功，3例中转开胸，其中1例因术中出血，1例为T3期肺部肿瘤，另1例因误伤左主支气管，中转开胸率为3％（3/100）。手术时间70-180min；术中出血量50-350ml。术后住院时间4-14d。围术期无死亡，并发症发生率17%，包括肺漏气、淋巴瘘、心律失常和肺不张等，均经相应处理治愈。结论扶镜者尤其需要掌握好扶镜的基本原则及方法，与术者默契配合，才能更快更好地完成手术。

Analysis of Clinical Skills of Camera Assistant for Completely Video-assisted Thoracoscopic Lobectomy

Objective Discuss the skills of camera assistant for complete video-assisted thoraeoscopie lobectomy. Methods We retrospectively analyzed the clinical data of 100 patients with pulmonary diseases undergoing completely video-assisted thoracoscopic lobectomy at our People between October 2008 and October 2012. Upper right lobectomy was carried out in 23 patients, right middle lobectomy in 7, lower right in 26, right middle and lower lobectomy in 2, upper left in 15, lower left in 27. All patients underwent completely video-assisted thoracoscopic lobectomy which was carried out through three mini-invasive incisions without the use of rib spreader. Systemic lymph node dissection was performed for patients with malignancies. Results Completely video-assisted thoracoscopic lobectomy was successfully performed in 97 patients, and the other 3 patients were changed to open thoracotomy due to bleeding in one patient, T3 tumor in one patient and accidentally injured bronchus in one patient. The overall conversion rate was 3% （3/100）. The mean operation time,blood loss and postoperative hospital stay were respectively 120＆#177;45minutes, 150＆#177;80ml, and 7＆#177;2days. No peri-operative death occurred. The overall complications rate was 17% , including lymphatic fistula, air leak, atrial fibrillation and atelectasis, and they all recovered after conservative treatment. Conclusion Thoracoscopic lobectomy is an intricate surgical procedure and requires a skillful camera assistant.