全胸腔镜肺叶切除术在肺良恶性疾病治疗中的应用

目的探讨全胸腔镜（VATS）肺叶切除术治疗肺良恶性疾病临床疗效。方法总结2010年8月～2012年9月采用胸腔镜治疗17例肺良恶性疾病的临床资料,其中右肺上叶6例,右肺下叶2例,右肺中叶2例,右肺中上叶1例,右肺中下叶2例,左肺上叶2例,左肺下叶2例。术后病理：鳞癌11例,腺癌2例,支气管扩张2例,硬化性血管瘤1例,错构瘤1例。结果1例因胸腔严重粘连,镜下处理困难而中转开胸行VATS辅助小切口手术,余16例全胸腔镜下完成。全组无围手术期死亡。手术时间80一240rain,平均140．2min;手术出血量50～800ml,平均150ml;切除淋巴结4～25枚,平均15．2枚;胸腔引流管留置时间48～92h,平均69．3h;术后总引流量200～900ml,平均300．5ml;术后住院天数7～14d,平均10．5d。回访所有患者均生存良好。结论全胸腔镜肺叶切除治疗肺良恶性疾病能够完成肺门及纵隔淋巴结的清扫,同时具有手术创伤小,出血少,术后疼痛轻,恢复快,并发症少的优点。     

胸腔镜亚肺叶切除术治疗肺部疾病的临床分析

目的探讨胸腔镜亚肺叶切除术在治疗肺部疾病的可行性、安全性及手术适应证。方法回顾性分析吉林大学白求恩第一医院胸外科于2012年9月至2014年9月行胸腔镜亚肺叶(肺段、肺楔形)切除手术的62例患者的临床信息,统计患者的手术时间、术中出血量以及术后并发症的临床资料。结果 62例患者均顺利完成胸腔镜亚肺叶切除手术(解剖性肺段切除及肺楔形切除术),无中转及扩大切口。手术所用时间62~230 min,平均(172±21.41)min;术中出血量80~300 ml,平均(180±12.79)ml。胸腔引流时间2~6 d,平均(3.5±0.41)d。术后住院3~10 d,平均(6±0.83)d。无二次手术,无输血,无围术期死亡。术后病理:腺癌28例,鳞癌10例,转移癌4例,炎性假瘤10例,结核球6例,肺囊肿2例,肺错构瘤2例,其中原发非小细胞肺癌均为Ⅰa期38例随访6~24 m,平均(15±1.69)m,38例肺癌均无复发、转移。结论胸腔镜亚肺叶切除术对于Ⅰa期非小细胞肺癌、肺孤立良性肿瘤(直径≤2 cm)、心肺功能较差以及合并其他疾病不能耐受肺叶切除手术的患者,不失为一种安全有效的手术。此术式因创伤小,失血量少,术后恢复快值得推广。     

胸腔镜肺叶切除术与肺段切除术治疗早期肺癌的临床分析

目的探讨胸腔镜肺叶切除术与肺段切除术治疗早期肺癌的有效性及安全性。方法选取我院2016年09月至2018年12月收治的早期肺癌患者75例,根据手术方式不同分为肺段切除组(34例)和肺叶切除组(41例)。观察2组患者手术时间、术中出血量、胸留置管时间、胸腔引流量、住院时间、并发症等相关指标以及术后肺功能、生活质量等指标的差异。结果肺段切除组患者术中出血、胸腔引流量、胸管留置时间、抗生素运用时间、住院时间、住院花费均低于肺叶切除组,但手术时间长于肺叶切除组,P<0.05。术后3d肺段切除组患者VAS低于肺叶切除组,P<0.05。肺段切除组术后3个月FVC%、FEV1(%)、MVV(%)高于肺叶组,P<0.05。肺段切除组术后3个月患者生理机能、精力、社会功能、精神健康的评分明显高于肺叶切除组,P<0.05。随访研究中2组患者复发率、1年生存率无统计学差异,P>0.05。结论胸腔镜肺段切除与肺叶切除手术效果及安全性相当,但肺段切除减少肺功能损伤,加快患者术后康复、改善患者生活质量。     

胸腔镜肺楔形切除术、胸腔镜下肺段切除术、胸腔镜肺叶切除术治疗早期肺癌的疗效比较研究

目的 比较胸腔镜肺楔形切除术、胸腔镜下肺段切除术和胸腔镜肺叶切除术治疗早期肺癌的疗效.方法 回顾性选取2017-06-01至2019-09-30东莞市人民医院心胸外科收治的早期肺癌患者112例为研究对象.根据手术方法将患者分为A组(胸腔镜肺楔形切除术,38例)、B组(胸腔镜下肺段切除术,36例)、C组(胸腔镜肺叶切除术...     

胸腔镜肺叶切除术(附23例报告)

回顾性总结23例（支气管扩张症2例，肺炎性假瘤1例，周围型肺癌20例）电视胸腔镜（CATS）肺叶切除术的经验与教训，并与周期常规开胸肺叶切除术（30例）的疗效进行对照比较，结合文献讨论了有关手术方法和治疗原则。认为只要严格把握好手术适应症，熟练掌握手术方法和技巧，VATS肺叶切除术治疗肺良性疾病和早期肺癌，可以达到与常规开胸手术同样的治疗效果。其术中出血量，术后引流量，引流时间，术后住院天数以及术后并发症发生率均低于常规开胸组，且具有创伤小，痛苦轻，恢复快，手术切口符合美学要求等优点。     

电视胸腔镜肺叶切除术的临床应用

微创外科（minimally ivasion surgery,MIS）是现代外科发展的趋势,应用电视胸腔镜技术（videoassisted thoracic surgery,VATS）进行肺叶切除术是近年来微创胸外科的热点之一[1]。自20世纪90年代胸腔镜逐步应用于临床以来,胸腔镜肺叶切除术已成为早期非小细胞肺癌（non—small cell lungcancer,NSCLC）治疗的主要手术方式[2-3]。     

单向式全胸腔镜肺叶切除术治疗肺癌14例临床分析

目的分析单向式全胸腔镜肺叶切除术的临床治疗效果并总结相关经验。方法 2009年1月-2010年2月为14例肺癌患者施行单向式全胸腔镜肺叶切除术,男性9例,女性5例,年龄55-73岁,平均66岁。结果 14例患者均手术成功,无严重并发症,原发性肺癌患者清扫纵隔淋巴结数量（8±4.2）枚,平均住院12天。结论单向式全胸腔镜肺叶切除术是一种安全有效的手术方式,效果确切尤其对初学者易操作、易掌握。     

全电视胸腔镜下肺叶切除术治疗老年肺部疾病32例的疗效

目的探讨全电视胸腔镜下肺叶切除术(VATS)治疗老年肺部疾病的可行性和近期疗效。方法回顾分析2006年4月至2012年1月,采用不撑开肋骨,完全在电视胸腔镜下完成肺叶切除术的32例老年肺部疾病患者,同时行纵隔淋巴结清扫术,其中右肺上叶9例,左上叶2例,右中叶2例,左下叶11例,右下叶8例。结果全组32例手术时间75～170 min,平均(120±30)min。年龄60～78岁。术中出血200～1 600 ml,平均(400±150)ml。术后切口延期愈合2例。术后病理:腺癌17例,鳞癌5例,细支气管肺泡癌1例,转移性腺癌1例,鳞腺癌2例,慢性肺脓肿1例,肺隔离症2例,支气管扩张3例。结论 VATS肺叶切除术治疗肺部疾病创伤小,安全可行,术后并发症小,恢复快。对于年龄较大不能耐受开胸手术的肺部疾病患者提供了一次手术治疗机会;对于只能耐受肺局部切除的老年患者,提供了可以耐受肺叶切除的根治性治疗机会。     

电视胸腔镜下肺叶切除术的护理体会

我院 1999年 12月至 2 0 0 1年 3月共施行电视胸腔镜 (下称VATS)下肺叶切除术 16例。现将护理体会讨论如下 :1　一般资料本组共 16例 ,其中男性 10例 ,女性 6例 ,年龄 2 5～ 75岁 ,平均 5 7岁。X线表现 :11例为孤立性团块或结节影 ,1例肺大泡 ,1例不规则肿块影 ,2例肺囊肿 ,1例毁损肺。本组 6例均在 VATS下施行了肺叶切除术。术后无呼衰及肺部感染等并发症发生。术后 2～ 3日均拔除胸管后可下床活动。胸液量平均 10 0 ml/d,低于常规天胸手术者。2　术前准备2 .1　健康教育 ,心理指导　了解患者及家属心理 ,介绍本手术的优点、适应症及患…     

全胸腔镜下肺叶切除治疗继发型肺结核

目的探讨全胸腔镜下肺叶切除治疗继发型肺结核的安全性、可行性和有效性。方法回顾性分析我院2009年9月~2013年12月完成的全胸腔镜下以肺叶切除为主的手术治疗继发型肺结核患者78例。记录中转开胸、手术时间、术中出血、术后引流液总量、带管时间、并发症和随访情况等。结果全组患者8例中转开胸,其余均在全胸腔镜下完成手术,手术平均时间(161.4±58.3)min;术中平均出血量(325.3±102.5)ml,术后平均引流液总量(1060.5±450.8)ml;术后平均带管时间(8.6±3.7)天;术后平均住院时间(10.4±3.9)天。出现术后并发症8例,其中肺漏气4例,引流液较多3例,切口延迟愈合1例。随访时间平均25.8个月,症状消失或好转,无复发、死亡患者。结论全胸腔镜下肺叶切除治疗继发型肺结核是一种安全、可行、有效的方法。     

Complete video-assisted thoracoscopic lobectomy of the left lower lobe and lung lymph node dissection

We describe herein a case of complete video-assisted thoracoscopic lobectomy of the left lower lobe and lung lymph node dissection. The patient was a 67-year-old man. A physical examination revealed a nodule in the left lower lobe that had been present for 7 years. According to the chest computed tomography (CT) report recently, a diagnosis of lung cancer was not excluded. Due to the surgical indications, he was underwent complete video-assisted thoracoscopic lobectomy of the left lower lobe and lung lymph node dissection. The frozen pathology report was consistent with adenocarcinoma. He recovered smoothly, without any perioperative complications.     

非插管与插管电视胸腔镜肺叶切除术治疗肺癌的比较

目的本研究旨在比较非插管和插管电视胸腔镜肺叶切除术治疗肺癌的早期手术效果。方法回顾分析2019年5月至2020年5月于我科同一医疗组行胸腔镜手术的患者的68例电视胸腔镜肺叶切除术(非插管式肺叶切除术34例,插管式肺叶切除术34例)。结果两组患者在年龄、性别、BMI、FEV;、DLCO、吸烟史、肺叶切除、组织学类型和病理分期等方面具有可比性。非插管组和插管组术后平均住院时间分别为9.3±3.8天和8.7±5.3天(P=0.624),闭式引流留置时间分别为3.6±2.0天和4.2±1.4天(P=0.867)。在麻醉持续时间、手术时间、出血量和术后并发症方面,两组的手术结果相似。非插管组肺叶切除术所需时间较短(非插管组平均为112.6±20.1分钟,插管组为123.7±30.4分钟)。两组间唯一有统计学意义的手术结果是淋巴结清扫数(未插管组的平均淋巴结数为13.9±7.0个,插管组为17.6±6.4个,P=0.004)。非插管组中有1例因出血需要改行单肺插管和小切口手术,插管组无中转手术。两组均无死亡病例。结论非插管电视胸腔镜肺叶切除术的早期疗效与插管组相当。非插管电视胸腔镜肺叶切除术是安全的,在技术上是可行的。然而,还需要进一步的前瞻性随机研究,以便更好地比较非插管和插管式胸腔镜肺叶切除术。     

Uniportal complete video-assisted thoracoscopic lobectomy with systematic lymphadenectomy

Video-assisted thoracoscopic surgery (VATS) has permeated our thoracic surgical practice and now will develop in depth towards a next level of minimally invasive surgery (MIS). Irrespective of generation gaps and diversified perception within thoracic community, more and more surgical teams are adapting to the uniportal lobectomy. This video demonstrates a case undergoing uniportal VATS lobectomy with systematic lymphadenectomy for lung cancer. We here describe our technique for uniportal approach by using a combination of double-jointed and endoscopic instruments to combat the four major obstacles: (I) interference of the thoracoscope, stapler and the instrumentation in and out of the thoracic cavity? (II) whether the field of vision is enough or not without the other 1-3 ports to improve the exposure? (III) the optimal stapler introduction angle especially for upper and middle lobes resection? (IV) more importantly, the oncologic validity of uniportal procedures as well as the reduction of postoperative morbidity? We believe, uniportal VATS lobectomy with systematic lymphadenectomy is technically safe and feasible and alternative approach to conventional thoracoscopic lobectomy in lung cancer treatment. The issues of patient acceptability, the cosmetic and oncologic results, and cost-effectiveness remain to be determined in the future through multi-institution randomized controlled trials and long-term follow-up.     

Uniportal complete video-assisted thoracoscopic surgery lobectomy with partial pulmonary arterioplasty for lung cancer with calcified lymph node

Now, more and more complete video-assisted thoracoscopic surgery (cVATS) surgeons are capable of performing lobectomy by uniportal approach. However, concerns regarding the safety of uniportal procedures for complex cases such as neoadjuvant chemotherapy, bronchial sleeves or vascular reconstructions still remains. As experience with uniportal VATS has increased, its application toward more technically demanding operations has also expanded. This article describes a uniportal cVATS left upper lobectomy with partial pulmonary arterioplasty for lung cancer with calcified lymph nodes. In order to reduce the risk of bleeding, we looped the left main pulmonary artery and applied two-stage maneuvering for left upper lobe (LUL) bronchus, cut the bronchus at the distal end and close the stump using a stapler at the end, which are conducive to maximal safety.     

Uniportal video-assisted thoracoscopic left upper lobectomy under spontaneous ventilation

Intubated general anesthesia with one-lung ventilation was traditionally considered necessary for thoracoscopic major pulmonary resections. However, non-intubated thoracoscopic lobectomy can be performed by using conventional and uniportal video-assisted thoracoscopic surgery (VATS). These non-intubated procedures try to minimize the adverse effects of tracheal intubation and general anesthesia but these procedures must only be performed by experienced anesthesiologists and skilled thoracoscopic surgeons. Here we present a video of a uniportal VATS left upper lobectomy in a non-intubated patient, maintaining the spontaneous ventilation.     

全胸腔镜下解剖性肺段切除术在GGO中的应用

目的探讨全胸腔镜下解剖性肺段切除术诊治肺部磨玻璃样阴影(GGO)的可行性及应用价值。方法回顾性分析2008年7月至2013年12月间39例GGO患者经胸腔镜肺段切除术治疗的临床资料。切除部位包括左肺上叶尖后段4例、固有段4例、前段1例、舌段6例,左肺下叶背段5例、基底段4例;右肺上叶尖段、前段、后段各1例,右肺下叶背段7例、基底段5例。术中标本送快速冰冻病理检查,若为良性则结束手术;恶性肿瘤患者清扫淋巴结4~7(4.8±0.2)组。结果全组手术顺利,无中转开胸。手术时间90~310(165±52)min,术中出血量30~200(67.5±12.7)ml,清扫淋巴结4~14(11.7±0.4)枚,无手术死亡及并发症,术后胸腔引流时间3~8(3.8±0.5)d。术后患者均顺利恢复,对肿瘤患者术后随访3~9个月内暂无复发、转移。结论全胸腔镜下解剖性肺段切除术诊治GGO是安全可行有效的,进一步降低了创伤,具有良好的应用价值。     

Efficacy and safety of video-assisted thoracoscopic surgery and thoracotomy in the treatment of pulmonary hydatid disease in the Tibetan Plateau: a retrospective study

BackgroundAlthough video-assisted thoracoscopic surgery (VATS) plays an increasingly significant part in treating thoracic disease, the role of thoracotomy is not replaced in cystic echinococcosis. The aim of this study was to demonstrate the application of VATS and traditional thoracotomy in the treatment of pulmonary hydatid disease in Shigatse of the Tibet Plateau and to compare the clinical safety and efficacy of these two surgical approaches.MethodsA total of 53 patients with pulmonary hydatid who received thoracoscopic cystectomy with needle aspiration from January 2015 to December 2020 were enrolled in the study, and 126 patients who received thoracotomy during the same period were matched as the control group. The clinical characteristics, operative time, incidence of perioperative complications, length of stay, and hospitalization cost of the VATS and thoracotomy groups were analyzed to compare the safety and efficacy. Patients were followed up through telephone and outpatient service. In order to balance potential confounding baseline factors, propensity-score matching (PSM) was applied to establish a 1:1 VATS to thoracotomy group ratio.ResultsThere were statistically significant differences between the VATS group and the thoracotomy group in operative time, blood loss, drainage volume, and postoperative hospital stay (P<0.05), with the VATS group being superior to the thoracotomy group. There were no significant differences in postoperative complications, adverse imaging outcomes, or recurrence rates between the 2 groups. In terms of complications, there was no significant difference in the incidence of postoperative air leakage, atelectasis, or other common complications between the 2 groups, while the frequency of postoperative fever and incision infection in the thoracotomy group was significantly higher than that in the VATS group (P<0.05). Moreover, the postoperative recurrence rate between the 2 groups showed no significant difference after a 3-year follow-up.ConclusionsCompared to traditional thoracotomy, VATS had acceptable efficacy and safety and it could further accelerate postoperative recovery and reduce the cost in the treatment of pulmonary hydatid disease in the Tibetan Plateau. Thus, VATS should be promoted more widely to other Tibetan regions.     

全胸腔镜肺叶切除治疗直径大于5厘米肺癌的初步体会

目的 探讨全胸腔镜肺叶切除治疗直径大于5 cm肺癌的临床疗效.方法 选取符合纳入标准的患者112例,其中男性69例,女性43例,年龄28~76岁.对肿瘤直径进行统计分析,并结合临床诊断确定病理的类型和病变的部位,统计手术时间以及术中出血、淋巴结清扫情况,生存复发数据等.结果 112例病患当中,109例于在全胸腔镜下完成了手术（手术时间134~225 min,术后引流量112~345 ml,平均住院12 d.结论 全胸腔镜下肺叶切除术在治疗直径大于5 cm肺癌上具有一定的疗效,适用于早期肺癌,且具有安全性和可靠性.