市级医院开展全胸腔镜袖式支气管肺叶切除治疗中心型非小细胞肺癌的可行性分析

目的 探讨市级医院行全胸腔镜下袖式支气管肺叶切除治疗早期中心型肺癌的临床应用及其适应证。方法 回顾分析2012年2月～2013年7月河南科技大学第一附属医院胸外科早期中心型非小细胞肺癌35例患者临床资料，所有患者均采用全胸腔镜袖式支气管肺叶切除术＋系统性淋巴结清扫的手术方式，观察患者的手术疗效及并发症发生情况。结果 35例患者均成功进行了全胸腔镜袖式支气管肺叶切除术加系统性淋巴结清扫．手术时间为（82．5±24．8）min，术中出血量为（350±45）mL。3例同时行支气管及肺动脉成形术，无围术期死亡。术后出现血胸1例，经通畅引流后好转，6例患者出现肺部感染，经抗炎，雾化吸入，气管镜吸痰后好转。无支气管胸膜瘘、肺不张、吻合口狭窄或瘘等并发症发生。结论 在市级医院开展全胸腔镜袖式支气管肺叶切除术治疗早期中心型非小细胞肺癌患者是一项安全、有效的手术方式。但必须严格掌握适应证、娴熟的手术技巧及术后并发症的预防措施。

Video-assisted thoracoscopic surgery bronchial sleeve lobectomy for centrally located NSCLC

Objective To explore the feasibility of video-assisted thoracoscopic surgery bronchial sleeve lobectomy for early stage center type of lung cancer in city level hospital and to summary its indication. Methods The clinical data of 35 patients with early stage centerally located NSCLC in Thoracic Surgery Department of the First Affiliated Hospital of He＇nan Science and Technology University from February of 2012 to July of 2013 were retrospectively analyzed. All the patients were treated with video-assisted thoracoscopic surgery bronchial sleeve lobectomy combined with systematic mediastinal lymphadenectomy. The operation effects and complications of all the patients were observed and analyzed. Results All the patients were operated with video-assisted thoracoscopic surgery bronchial sleeve lobectomy combined with systematic mediastinal lymphadenectomy sussessfully, and the operative time was （82.5±24.8） min, the blood was （350±45）mL. The operation of bronchi and pulmonary artery forming was used in 3 cases. The complication of hemothorax was happened in 1 case, who was healed after unobstructed drainage, perioperative death were not occurred, and the pulmonary infection in 6 cases were healed after anti-inflammatory, aerosol inhalation and bronchoscope sputum suction. The complications of bronchopleural fistula, pulmonary atelectasis and anastomotic stenosis or fistula were not occurred. Conclusion Video-assisted thoracoscopic surgery bronchial sleeve lobectomy for early stage centerally located NSCLC in city level hospital is an effective and safe method, but need to master the indication strictly, skilled technology and the precaution of complication.