电视胸腔镜肺叶切除治疗早期非小细胞肺癌初期体会

目的：评估初期开展全胸腔镜肺叶切除治疗早期非小细胞肺癌的疗效，总结治疗经验。方法：回顾性分析2008 年6 月～2009年12 月本组开展的 56 例全胸腔镜肺叶切除的临床资料，按照国内外成熟的学习曲线例数和个人体会，将最初的 6 个月病例定为 A组（n=26 ），之后的例数为 B 组（n=30 ），分析初期开展此项技术的学习曲线与手术效果的关系。结果：56 例患者均康复出院，术中无中转开胸。术后并发症发生率（%）：（包括肺不张、肺梗塞、房颤、心功能衰竭、切口感染、肺部感染、术后漏气时间（>5d）A 组分别为0、0、0、3.85 %、7.69 %、7.69 %、23 .08 %，B 组分别为 0、0、0、0、0、3.33 %、13 .33 %；A 组使用耗材（6.21 ±1.32 ）个、主操作孔长度（5.71 ±2.11 ）cm、住院时间（12 .91 ±2.52 ）d、术后胸管留置时间（6.19 ±2.05 ）d 和淋巴结清扫数目（10 .24 ±1.91 ）枚与B 组（5.67 ±1.73 ）个、（4.32 ±1.63 ）cm、（7.33 ±2.26 ）d、（4.43 ±1.12 ）d、（13 .92 ±2.23 ）枚比较无显著性差异﹙P>0.05 ﹚；A 组在出血量（262.46 ±50 .15 ）mL、手术时间（209.35 ±21 .71 ）min、费用（4.63 ±1.12 ）万元明显多于B 组的（147.32 ±22 .55 ）mL、（157.34 ±21 .26 ）min、（3.52 ±1.51 ）万元，两组比较有显著性差异﹙P<0.05﹚。结论：全胸腔镜肺叶切除治疗早期非小细胞肺癌学习曲线初期研究表明，大量的开胸经验和熟练的腔镜操作技术是前提，良好的心理素质是手术成功的关键，合理的效价比则更能为广大患者接受。

Experience of Pulmonary Lobectomy with Video-Assisted Thoracic Surgery for Non-Small Cell Lung Cancer of Early Stage

Objective:To discuss the clinical experience after video-assisted thoracic surgery (VATS) lobectomy for ear -ly stage lung cancer treated in the first VATS phase. Methods:From June 2008 to December 2009, researchers proposed VATS for56 major pulmonary resections. The clinical information was collected and the relationship between learning curve and surgery effectiveness was analyzed.Results: This study successfully performed VATS procedure for 56patients who were diagnosed as having lung cancer. There was no mortality. The incidence rate of major complications such as atel-ectasis, pulmonary embolism, atrial fibrillation, heart failure, incision infection, pulmonary infection, and air leak prolonged (> 5d) was 0, 0, 0, 3.85%,7.69%,7.69% and 23.08%, respectively, in group A and 0, 0, 0, 0, 0, 3.33%,13.33%, respectively, in group B. There were significant deviations ( P<0.05) between group A and B such as blood loss (ml), operative time (min), the group number of lymphonodes, hospital stay (d), postoperative chest tube drainage (d) and cost ( ￥100 ,000 ), but no significant deviation in quantity of single use apparatus and length of chief incision ( P>0.05). Conclusion:VATS lobecto-my is a safe and effective approach. In the first phase, expert telescope skill is an antecedent need, accurate position of the incision and clear psychological diathesis is very important, advisable potency ratio will be accepted by the patients.