胸腔镜辅助小切口肺叶切除术治疗肺癌临床研究

目的探讨电视胸腔镜辅助小切口(VAMT)肺叶切除术治疗肺癌的手术方式和适应症.方法应用VAMT肺叶切除术治疗肺癌33例.作1.5 cm胸腔镜切口及腋下7～10 cm操作切口,采用常规开胸手术器械与内镜器械相结合直视操作行肺叶切除、内镜 直视下行纵隔肺门区淋巴结清扫.并与同期33例肺癌常规开胸肺叶切除术进行比较研究.结果VAMT组33例肺叶切除术顺利完成,出血少,均未输血,无特殊并发症,术后恢复良好.与常规组比较在淋巴结清扫数量、范围、淋搬和病人转移率方面无显著差异;而手术时间、失血量、术后胸液量和术后住院天数VAMT组优于常规组.结论VAMT肺叶切除术治疗肺癌,将VATS技术与传统开胸技术相结合,既发挥了微创外科的优越性,又达到了传统开胸手术安全、可靠的效果,清扫淋巴结符合肿瘤手术原则.既适合于肺部良性病变,也适合于多数周围型肺癌病人的手术治疗,但应严格掌握手术适应症.

Clinical study of video-assisted minithoracotomy lobectomy in patients with lung cancer

Objective To evaluate the technique and the indication of Video- assisted minithoractomy(VAMT) lobectomy for patients with lung cancer. Methods Between May 2000 and October 2003. 66 patients with lung cancer successfully underwent either VAMT lobectomy (VAMT group;n = 33) or conventional lobectomy (open group;n = 33). The minimal thoractomy from 7 to 10cm was made at fourth or fifth intercostal space and lobectomy was underwent for conventional or dedicated endoscopic instruments in VAMT group. Lymph node dissections were perfomed in a manner in both groups. Results It was satisfactory without operative mortality and postoperative complications. No significant differences were observed in the two groups with respect to the total number and metastatic number of mediastinal and hilar region lymph nodes dissected. The intraoperative blood loss significantly less in the VAMT group and the postoperative total amount effusion was also less. The length of postoperative hospitalization as also shorter in the VAMT group. Conclusion The VAMT lobectomy is a safe and reliable and less invasive approach in benign lesions and in primary lung cancer. Nevertheless, it is important to adhere to indication and longer follow - up is also necessary.