全电视胸腔镜下肺叶切除术156例报告

目的探讨全电视胸腔镜下肺叶切除术治疗肺部疾病的价值。方法 2008年1月～2011年1月,通过胸部3个微小切口行全电视胸腔镜下肺叶切除术156例,无须放置肋骨撑开器,不牵开肋骨,基本操作顺序与常规开胸肺叶切除相同。肺癌病人均清扫淋巴结。结果本组手术顺利,无围手术期严重并发症及死亡,手术时间(166±58)min,术中出血(210±108)ml,术后住院时间(8.3±3.0)d。术后病理诊断:肺部良性病变28例(17.9%),其中隐球菌感染16例,结核球7例,肺不张5例;肺部恶性肿瘤128例(82.1%),其中细支气管肺泡癌72例,腺癌26例,细支气管肺泡癌合并腺癌17例,鳞癌13例。156例术后随访3～36个月,平均13个月:28例良性疾病无远期感染性并发症;128例恶性肿瘤中,术后3年内发生远处转移6例,主要为脑、肾上腺转移;无死亡病例。结论全电视胸腔镜下肺叶切除术安全、有效。

Complete Video-assisted Thoracoscopic Lobectomy:Report of 156 Cases

Objective To evaluate complete video-assisted thoracoscopy(VAT) for lobectomy in pulmonary diseases.Methods From January 2008 to January 2011,we performed lobectomy by VAT on 156 patients with pulmonary diseases.Through three minimal incisions on the chest,we carried out the procedure as that of traditional open lobectomy without placing a rib retractor.Lymph nodes were resected in the patients with lung cancer.Results No death nor severe complications occurred perioperatively.The mean operation time was(166±58) min,and mean intraoperative blood loss was(210±108) ml.The patients were discharged from hospital in(8.3±3.0) d after the procedure.Postoperative pathological examination revealed benign pulmonary diseases in 28 cases(17.9%),including Cryptococcus infection in 16 patients,TB nodule in 7,and atelectasis in 5;the other 128 cases were diagnosed with malignancies,including bronchioalveolar carcinoma in 72 cases,adenocarcinoma in 26,bronchioalveolar carcinoma complicated with adenocarcinoma in 17,and squamous carcinoma in 13.Among the patients,156 cases achieved a follow-up for 3 to 36 months with a mean of 13 months;during which,28 benign cases showed no long-term infective complications,6 of the 128 malignant cases developed metastasis to the brain or adrenal gland in three years.No patient died during the follow-up.Conclusion Lobectomy under VAT is safe and effective.