全胸腔镜肺叶切除术治疗周围型肺癌的临床分析

目的探讨全胸腔镜肺叶切除术在治疗周围型肺癌患者中的应用。方法回顾性分析2009年7月至2011年12月安徽医科大学附属省立医院应用全胸腔镜肺叶切除术治疗90例周围型肺癌患者的临床资料,其中男55例,女35例;年龄33～79(62.5±11.5)岁。观察术中淋巴结清扫组数、手术时间、术中出血量、术后胸腔引流时间、术后住院时间、并发症发生率和疼痛评分。结果围术期无死亡。手术时间(135.0±32.5)min,术中出血量(230.0±80.4)ml,术后胸腔引流时间(4.8±2.1)d,术后第3 d疼痛评分(5.3±1.2)分。共清扫淋巴结520组,1 568枚,5.8组/例、17.4枚/例;淋巴结有转移71组,阳性率13.7%(71/520)。术后发生声音嘶哑2例;乳糜胸3例,经相应的治疗均治愈。随访90例,随访时间1～24个月,随访期间因肿瘤转移死亡4例;其余生存患者生活质量良好。结论对周围型肺癌患者采用全胸腔镜肺叶切除术治疗,具有创伤小、恢复快和疼痛轻等优点。手术安全性、根治性与开胸手术相似,可作为治疗周围型肺癌患者的手术方式。

Clinical Analysis of Complete Video-assisted Thoracoscopic Surgery Lobectomy for Patients with Peripheral Lung Cancer

Objective To evaluate clinical outcomes of complete video-assisted thoracoscopic surgery(VATS) lobectomy for patients with peripheral lung cancer.Methods We retrospectively analyzed clinical data of 90 consecutive patients with peripheral lung cancer who underwent complete VATS lobectomy from July 2009 to December 2011 in Provincial Hospital Affiliated to Anhui Medical University.There were 55 male patients and 35 female patients with their age of 33-79(62.5 ±11.5) years.Lymph node dissection group and number,operation time,intraoperative blood loss,length of postoperative chest drainage,length of postoperative hospitalization,postoperative morbidity and pain score were analyzed.Results There was no hospital death in this group.Operation time was 135.0±32.5 min,intraoperative blood loss was 230.0±80.4 ml,length of postoperative chest drainage was 4.8±2.1 days,and pain score on the third postoperative day was 5.3±1.2.A total of 520 groups and 1 568 lymph nodes were dissected during the operation,with 5.8 groups and 17.4 lymph nodes dissected in each patient.There were 71 groups with lymph node metastasis,a positive rate of 13.7%(71/520).Postoperatively,2 patients had hoarseness and 3 patients had chylothorax,who were all cured after proper treatment.Ninety patients were followed up for 1-24 months.During follow-up,4 patients died of tumor metastasis,and other patients were all alive with good quality of life.Conclusion Complete VATS lobectomy is a minimally invasive technique for patients with peripheral lung cancer with better postoperative recovery and reduced pain level.The safety and degree of radical resection of complete VATS lobectomy is similar to those of routine thoracotomy lobectomy.Complete VATS lobectomy can be recommended as a surgical treatment for patients with peripheral lung cancer.