肺良性肿瘤胸腔镜摘除术--附5例报告

目的：探讨胸腔镜肺良性肿瘤摘除术的方法和价值。方法：2001年1月－2002年4月，对5例患者行VATS肺良性肿瘤摘除术。男1例，女4例，平均年龄37．2岁。术前均诊断为良性结节：周围型3例，左下叶肺动脉旁1例，左上叶舌段近肺门1例。双腔气管插管单肺通气，按常规位置做3个套管切口。镜下切开结节表面脏层胸膜，沿肿瘤包膜钝性剥离。靠近肺门血管旁的2例病例，采用缝线牵引法协助剥离。摘除之肿瘤立即送快速病理除外恶性病变。将手术结果与同期进行的胸腔镜肺良性肿瘤楔形切除术组进行比较。结果：手术顺利，无中转开胸；术后胸腔引流1－8d，平均2.8d；术后住院2－9d，平均5d；5例仅用Endo GIA钉夹1枚；病理：硬化性血管瘤3例，错构瘤1例，神经鞘瘤1例。并发症1例。为长期漏气（8d)，无死亡。与肺楔形切除术组相比，在闭式引流时间及术后住院时间上无显著差异；平均住院费用较少，但无统计学差异。随访至今无复发。结论：胸腔镜摘除术是治疗肺良性肿瘤的一种简便、安全、可靠的微创新术式。

VIDEO-ASSISTED THORACOSCOPIC ENUCLEATION OF BENIGN LUNG TUMORS (REPORT OF FIVE CASES)

Objective:To evaluate the merit of a new procedure-video assisted thoracoscopic (VATS) enucleation in treatment of benign lung tumors.Methods:From Jan. 2001 to Apr. 2002, 5 patients had received VATS enucleation procedures. There were 1 male and 4 females, mean 37.2 yrs. Preoperative diagnosis were benign tumors. General anesthesia were introduced with double lumen endotracheal intubations. Three trocar ports were made in each case in regular arrangement. Tumors were enucleated by blunt resection. Sutures were added for traction in two cases whose lesions were near the hilum to facilitate resections. Tumors resected were immediately transferred to get frozen sections to eliminate any malignancies. Data was compared with that of VATS wedge resections.Results:All procedures were accomplished uneventfully except one prolonged air leak (8 days). There was no conversion to thoracotomy. Mean chest tube drainage time was 2.8 days. Mean postoperative hospitalization was 5 days. Only one piece of Endo GIA cartridge was used in 5 patients. Pathologic diagnosis were as follows: sclerosing hemangioma for 3, hamartoma for 1 and neurilemmoma for 1. There wasn't any difference between enucleation and wedge resection in postoperative drainage time and hospitalization. The total hospital charge seemed lower in enucleation group than wedge resection group, but there was no statistic difference.Conclusions:Video-assisted thoracoscopic enucleation is a new method in treating benign lung tumors which is as safe as wedge resection by Endo GIA.