单操作孔胸腔镜肺叶切除术的初步报道

背景与目的电视辅助胸腔镜外科手术(video-assisted thoracoscopic surgery,VATS)已被广泛应用于胸部疾病的诊断和治疗,本研究旨在探讨单操作孔VATS肺叶切除术的可行性及临床价值。方法2009年9月-2009年12月,我院采用单操作孔胸腔镜肺叶切除术21例,所有手术操作均在胸腔镜下完成,其中右上肺叶切除12例,左下肺叶切除5例,右下肺叶切除2例,左肺上叶切除1例,右肺中叶切除1例。结果全部患者手术过程顺利,无中转开胸。平均手术时间(132.7±16.2)min,术中出血(110.5±24.6)mL;胸腔引流管拔出时间(3.1±1.3)d;术后住院时间(5.2±3.2)d。全部患者术后恢复顺利,无肺不张、肺部感染、出血等并发症,无围手术期死亡。结论单操作孔胸腔镜肺叶切除术在技术上是安全、可行的,具有创伤更小、恢复更快等优点。     

单操作孔胸腔镜治疗早期肺癌临床体会

目的:探讨单操作孔胸腔镜肺叶切除术治疗早期肺癌的临床效果。方法:回顾性分析2011年1月至2013年12月我院应用VATS治疗的97例早期肺癌患者的病例资料,其中单操作孔VATS手术患者43例（单操作孔组）,两操作孔VATS手术患者54例（两操作孔组）。比较手术时间、术中出血量、清扫淋巴结数、胸腔引流管时间及术后住院时间等参数。结果:两组患者均无围手术期死亡。单操作孔组术后引流管留置时间、术后住院时间、术后24小时疼痛评分等均低于两操作孔组（P<0.05）。而术中出血量、手术时间、清扫淋巴结数及术后并发症发生率无显著性差异（P>0.05）。结论:单操作孔VATS肺叶切除并淋巴结清扫术治疗早期肺癌是安全可行的,较两操作孔VATS可减少患者创伤。     

单操作孔胸腔镜右肺上叶简约式切除的临床观察

目的 探讨单操作孔胸腔镜右肺上叶简约式切除术治疗肺癌的可行性。方法 回顾性分析2015年12月至2016年12月采用单操作孔胸腔镜右肺上叶简约式切除术的25例肺癌患者的临床资料,并观察手术时间、失血量、带管时间及住院时间等指标。结果 所有患者均在单操作孔下顺利完成手术,平均手术时间为（90±10.6）min,平均失血量为（60±5）ml,平均带管时间为（5±0.5）d,平均住院时间为（9.7±0.5）d。术后4例患者出现肺不张伴肺内感染。结论 单孔胸腔镜右肺上叶简约式切除术治疗右肺上叶肺癌,手术方法简便,安全可靠,但需要患者的肺裂分化良好,且术者技巧熟练,值得广泛应用。     

单向式胸腔镜肺叶、全肺切除及淋巴结清扫手术体会

摘 要：［目的］ 探讨单向式胸腔镜肺叶、全肺切除及淋巴结清扫手术的流程及效果。［方法］ 回顾性分析完成单向式胸腔镜肺癌手术的患者57例。其中中央型肺癌21例,周围型肺癌36例。57例中行右肺上叶切除14例,右肺下叶切除10例,左肺上叶切除12例,左肺下叶切除13例,左全肺切除5例,右全肺切除3例。中转开胸4例。［结果］ 全组平均手术时间109min(80～170min),术中平均失血120ml(10～500ml),清扫淋巴结个数12枚(9～18枚),术后总引流量平均440ml(20～3000ml),术后引流管保留时间平均3d(2～8d),术后住院平均7.1d(4～13d)。［结论］ 单向式全胸腔镜肺叶、全肺切除及淋巴结清扫手术是安全可行的,操作系统规范,值得学习应用。     

全胸腔镜下手术治疗26例早期肺癌的体会

目的探讨全胸腔镜下手术治疗早期肺癌的安全性、可行性及手术适应症。方法所有患者均在3个微小切口非直视下行解剖性肺叶切除,同时行淋巴结清扫术。行左肺上叶切除术5例,左肺下叶切除术7例,右肺上叶切除术6例,右肺中叶切除术3例,右肺下叶切除术5例。结果术中无中转开胸、无二次手术、无输血、无严重并发症及围手术期死亡者。手术时间为（163.07±20.83）min,出血量（255.77±51.83）ml,术后引流量（348.04±39.13）ml,术后住院时间（9.96±0.82）天。术后随访6～12个月无复发。结论全胸腔镜下肺叶切除术是1种安全、有效、微创的术式,适用于早期肺癌患者。     

电视胸腔镜在肺癌手术治疗中的应用

目的 探讨电视胸腔镜在肺癌完全性及姑息性手术治疗中的作用。方法 2002年2月至2003年8月采用电视辅助胸腔镜手术(VATS)治疗肺癌43例。其中ⅠA期5例，ⅠB期14例，ⅡA期1例，ⅡB期4例，ⅢA期7例，T4-ⅢB期6例，Ⅳ期6例。ⅢA期术前临床评估为N0，术后病理查见N2转移。ⅢB期病例中3例为恶性胸水,3例为术中发现胸腔种植转移。Ⅳ期病例中2例为晚期肺癌伴恶性心包积液-心脏压塞；1例为孤立脑转移瘤切除术后；3例为对侧或同侧肺孤立性转移。主要手术方式：肺叶切除36例，肺楔形切除5例，心包开窗2例。其中2例同期行对侧孤立性肺转移瘤楔形切除；恶性胸水行胸膜种植结节切除、烧灼，胸膜粘连术。行纵隔淋巴结清扫36例。结果 无围术期死亡，无支气管胸膜瘘发生，肺部感染5例，切口液化2例。3例恶性胸水均得到控制。2例心包开窗引流患者分别于术后4个月、8个月死亡。其余患者目前仍存活。除2例心包开窗引流患者．外科术后住院时间为5～15天，平均7.4天。结论 VATS适合早期肺癌的完全性切除手术治疗，对偶然性N0肺癌手术中行纵隔淋巴结清扫是可行的。对肺癌需同期双侧开胸手术者VATS具有显著优势。VATS对恶性胸水、心包压塞的姑息性治疗能明显提高患者生活质量。     

计算机断层扫描三维重建联合带钩钢丝定位对ⅠA期肺癌的诊疗价值研究

目的探讨计算机断层扫描(CT)三维重建联合带钩钢丝(Hookwire)定位在ⅠA期肺癌诊疗中的应用效果。方法选取94例孤立性肺结节(SPN)患者作为研究对象,根据术后病理分为恶性SPN组(60例)和良性SPN组(34例)。记录并比较两组患者术前病灶影像学特征,记录患者电视胸腔镜手术(VATS)手术情况,包括手术时间、术中出血量、住院时间及Hookwire定位操作和VATS手术相关并发症。结果良恶性SPN病灶血管集束征、空泡征及左右肺分布比例比较,差异均无统计学意义(P﹥0.05)。恶性SPN边界不规则、毛刺征、分叶征、胸膜凹陷征、内部钙化灶和肺上叶比例均高于良性SPN病灶,差异均有统计学意义(P﹤0.05)。Hookwire定位针首次定位成功率为98.94%(93/94),二次定位成功率为100%。术中发现定位针脱落2例(2.13%),VATS楔形切除手术成功率为98.94%,1例因胸膜粘连严重转行微创开胸手术。VATS楔形切除手术时间为(20.75±8.22)min,术中出血量(26.58±9.43)ml,术后住院时间(5.45±2.16)d。定位操作和术后并发症发生率分别为17.02%(16/94)和4.26%(4/94)。结论CT三维重建联合Hookwire定位较好地解决了ⅠA期肺癌精准定位切除的问题,但也存在定位针脱落等风险,仍需进一步研究论证。     

电视胸腔镜辅助小切口切除肺癌十例

我院自 2 0 0 2年 8月～ 2 0 0 3年 5月采用胸腔镜辅助小切口完成肺癌切除术 10例 ,效果满意 ,现总结报告如下。1　临床资料1.1　一般资料　本组男 7例 ,女 3例 ;年龄 46～ 69岁 ,平均 5 3 .4岁。均为周围型肺癌 ,肿瘤直径 2～ 5cm ,其中左肺下叶 5例 ,左肺上叶 1例 ,右肺下叶 4例 ,均行相应肺叶切除术 ;TNM分期为Ⅰ期 2例 ,ⅡA期 5例 ,ⅡB期 3例 ;清除淋巴结 46枚 ,其中癌转移者 6枚。均经病理证实 ,切缘无残留癌。1.2　手术方法　采用全麻、双腔气管插管、单肺通气手术。左侧或右侧卧位 90° ,胸下部常规放一软垫 ,手术床略摇至头低位 ,…     

电视胸腔镜肺癌肺叶切除及纵隔淋巴结切除术

作者报告了电视胸腔镜手术(VATS)肺癌肺叶切除术的经验,探讨胸腔镜肺癌切除术的并发症、死亡率、住院时间及根治术的可能性。 应用VATS连续对45例年龄44～82岁的肺癌施行肺叶切除术及纵隔淋巴结切除。大于70岁者13例,大于80岁者7例。肿瘤直径 小于5cm者44例,6cm者1例。手术常规检查或切除淋巴结,近期病例切除淋巴结多达26(15～26)枚。 手术时间平均125(45～240)分钟。VATS附加开胸术4例。术中用血管钉书机切断肺动     

支气管、隆凸及肺血管成形术治疗中央型肺癌92例临床分析

背景与目的 外科手术是早、中期非小细胞肺癌的首选治疗方案.本文总结支气管袖状、隆凸切除及支气管肺动脉双袖状成形术等手术方式治疗92例中央型肺癌的临床经验.方法 对我院1996年1月-2010年5月间92例中央型肺癌患者施行以支气管袖状成形术为主的多种切除重建手术.其中右肺上叶支气管袖状切除术49例,左肺上叶袖状切除术14例,右肺中叶袖状切除术3例,左肺下叶袖状切除术4例,左肺支气管肺动脉双袖状成形肺叶切除术8例,右肺上叶切除合并器官隆凸切除重建3例,全肺切除合并气管隆凸切除重建术7例,主气管袖状切除4例.结果 无围手术期死亡病例,平均手术时间2 h 43min,平均失血415 mL,术后肺不张7例(7/92),声音嘶哑4例(4/92),机械通气支持3例(3/92).1年、3年、5年生存率分别为80.7%、59.6%、31.5%.结论 隆凸切除、支气管袖状成形术、支气管肺动脉双袖状成形术等术式既能最大限度地切除肿瘤,又能最大限度保护了肺功能,且隆凸切除气道重建术能进一步扩大手术适应症,提高了中央型肺癌的手术切除率.     

Application of Video-Assisted Thoracic Surgery in the Standard Operation for Lung Tumors

OBJECTIVE To evaluate the indication and short-term outcomes of video assisted thoracic surgery (VATS) for lung tumors. METHODS Data of 306 consecutive patients undergoing VATS pulmonary resection between January 2009 and August 2010 in Cancer Institute & Hospital, Chinese Academy of Medical Sciences were retrospectively reviewed. RESULTS There were 7 patients who underwent open thoracotomy, accounting for 2.29% (7/306). The overall morbidity rate of complications and the mortality rate induced by VATS was 1.63% (5/306) and 0.33% (1/306), respectively. There were no significant differences in morbidity and mortality rate between the patients receiving the VATS and the patients receiving the OT. The overall hospitalization, postoperative length of stay (LOS) and chest tube duration in the VATS lobectomy group (n = 167) were shorter than those in the open thoracotomy (OT), but the operative time in the VATS group was longer than that in the OT group (n = 124). There were no signifi cant differences in the number of station of lymph nodal dissection (LND) and number of LND in pathological stage I between VATS group and OT group, but signifi cant differences were found in the number of station of LND and the number of LND in pathological stage II and stage IIIA between the 2 groups. Compared with those who underwent OT wedge resection (n = 72), the patients who underwent VATS wedge resection (n = 108) had shorter operative time, chest tube duration and hospital LOS, and there were no significant differences in morbidity of the complications and mortality between the 2 groups.CONCLUSION VATS lobectomy can be performed for patients with clinical stage I lung cancer (with tumor diameter smaller than 5 cm, without hilar and mediastinal lymph node enlargement). VATS lobectomy is superior to OT lobectomy in short-term outcomes, although further studies exploring long-term outcomes through longer follow-up is needed to determine the oncologic equivalency between the VATS and the open lobectomy. VATS is also superior to OT in pulmonary wedge resection.     

完全电视胸腔镜与电视胸腔镜辅助小切口行肺癌根治术的临床研究

目的探讨完全电视胸腔镜行肺癌根治术的临床价值。方法选取2009年3月至2012年8月收治的287例非小细胞肺癌患者,其中209例在完全电视胸腔镜下行肺癌根治术（VATS组）,78例电视胸腔镜辅助小切口行肺癌根治术（VAMT组）,比较分析两组围手术期相关临床指标的变化。结果两组均无严重并发症和围手术期死亡。VATS组与VAMT组比较,在手术时间、淋巴结清扫个数、术中出血量和术后胸腔置管时间等方面差异无统计学意义（P〉0.05）。术后住院时间、术后1天血清C反应蛋白（CRP）中CRP含量等方面差异有统计学意义（P〈0.05）;VATS组平均住院天数（9.0±2.1天）较VAMT组（13.1±2.4天）短;VATS组术后1天CRP值（43.1±11.7 mg/L）较VAMT组（62.6±15.1 mg/L）优。结论完全电视胸腔镜肺叶切除可彻底清扫淋巴结,急性期反应程度轻、恢复较快、住院时间短,是非小细胞肺癌的良好手术途径。     

全胸腔镜肺癌根治术在治疗高龄患者中的价值

目的探讨全胸腔镜肺叶切除及纵隔淋巴结清扫术在治疗高龄非小细胞肺癌(non-small cell lungcancer,NSCLC)患者中的价值。方法 回顾分析225例接受该术式的NSCLC患者的临床资料,对比38例高龄(≥70岁)与随机抽取的57例非高龄(<70岁)患者的手术创伤、术后恢复、术后并发症及早期预后。结果 两组患者在手术创伤、术后恢复方面无差异;高龄组患者术后心血管并发症发生率高于非高龄组(23.7%vs 1.8%,P=0.001),其余并发症没有增多;术后生存分析两组无差异。结论 该术式治疗高龄NSCLC患者安全可行且疗效良好。     

电视胸腔镜与开胸肺癌切除淋巴结清扫的对比研究

目的：探讨电视胸腔镜肺癌切除术淋巴结清扫的彻底性和完全性。方法：50例准备常规开胸切除的肺癌患者先采用电视胸腔镜行肺叶切除＋纵隔淋巴结清扫术,随后再接受同组医师的开胸肺门纵隔淋巴结清扫。对开胸后清扫的淋巴结单独标注、计数后送组织病理学检查。结果：50例胸腔镜肺癌切除淋巴结清扫术后,开胸重新清扫淋巴结数共48枚,每例0枚～3枚,平均0．96枚。病理检查全部未查见癌细胞转移。结论：电视胸腔镜肺癌切除淋巴结清扫是彻底的、完全的。     

肺癌术后乳糜胸的治疗对策

目的：回顾肺癌肺切除和淋巴结清扫术后并发乳糜胸的病例，分析其治疗对策方法：1997年7月～2003年12月，共1546例肺癌患者行肺切除术(至少是肺叶切除术)并行系统的淋巴结清扫其中16例术后并发乳糜胸，均以保守治疗(闭式引流，胸腔内注药，全胃肠外营养或低脂饮食)。结果：全部16例均经保守治疗治愈该组患者在乳糜胸确诊后经6-2l天治疗，平均于9．8天后可进正常饮食胸引流量最多2100ml／天。结论：由于解剖及生理的原因，以及各种营养支持治疗的进展使其保守；台疗的成功率不断提高，我们认为该类术后乳糜胸如果处理得当，完全可以保守治疗治愈。     

Safety and feasibility of video-assisted thoracoscopic surgery for stage ⅢA lung cancer

Objective： The current study was prospectively designed to explore the application of video-assisted thoracoscopic surgery （VATS） radical treatment for patients with stage ⅢA lung cancer, with the primary endpoints being the safety and feasibility of this operation and the second endpoints being the survival and complications after the surgery. Methods： A total of 51 patients with radiologically or mediastinoscopically confirmed stage ⅢA lung cancer underwent VATS radical treatment, during which the standard pulmonary lobectomy and mediastinal lymph node dissection were performed after pre-operative assessment. The operative time, intraoperative blood loss/ complications, postoperative recovery, postoperative complications, and lymph node dissection were recorded and analyzed. This study was regarded as successful if the surgical success rate reached 90% or higher. Results： A total of 51 patients with non-small cell lung cancer （NSCLC） were enrolled in this study from March 2009 to February 2010. The median post-operative follow-up duration was 50.5 months. Of these 51 patients, 41 （80.4%） had N2 lymph node metastases. All patients underwent the thoracoscopic surgeries, among whom 50 （98%） received pulmonary lobectomy and mediastinal lymph node dissection completely under the thoracoscope, 6 had their incisions extended to about 6 cm due to larger tumor sizes, and 1 had his surgery performed using a 12 cm small incision for handling the adhesions between lymph nodes and blood vessels. No patient was converted to conventional open thoracotomy. No perioperative death was noted. One patient received a second surgery on the second post-operative day due to large drainage （〉1,000 mL）, and the postoperative recovery was satisfactory. Up to 45 patients （88.2%） did not suffer from any perioperative complication, and 6 （11.8%） experienced one or more complications. Conclusions： VATS radical treatment is a safe and feasible treatment for stage ⅢA lung cancer.     

Video-assisted thoracoscopic pneumonectomy: a minimally invasive approach for a rare inidication

Minimally invasive video-assisted thoracoscopic surgery (VATS) is considered as an alternative to thoracotomy for early stage lung cancer. Since 2009, we use a VATS approach for all early stage lung tumors as well as benign indications for lung lobectomy. As experience with the technique is growing, indications are expanded. Here, we report our first minimally invasive pneumonectomies of two patients with non-small cell lung cancer (NSCLC). Case 1: A 60-year-old man was diagnosed with a centrally located tumor of the right lung invading all three lobes without any obvious lymph node metastasis in the preoperative work-up. The patient was scheduled for a right-sided VATS pneumonectomy. Case 2: A 62-year-old woman was diagnosed with a centrally located tumor of the left lung with an ipsilateral positron emission tomography (PET) positive lymph node (aortopulmonary window). After neoadjuvant treatment, the patient was scheduled for a left-sided pneumonectomy. Written informed consent was given in both cases. The procedures were completed using three incisions. A complete mediastinal lymph node dissection was performed. The postoperative courses were uneventful. VATS pneumonectomy is feasible in highly selected cases. It offers all advantages known from minimally invasive lung lobectomy with less pain and faster rehabilitation, which might facilitate the delivery of adjuvant treatment.