电视胸腔镜辅助小切口肺癌根治术34例分析

目的探讨电视胸腔镜辅助小切口肺叶切除术在肺癌手术的应用。方法2004年7月至2009年7月行电视胸腔镜辅助小切口肺癌根治术34例，其中IA期2例，IB期2例，ⅡA期11例，ⅡB期13例，ⅢA期6例。周围型肺癌27例，中央型肺癌7例。全麻双腔气管插管，于患侧腋中线第8或第9肋间作一长约2．0cm切口，置入胸腔镜。于第4或第5肋间作长约4．0～10．0cm横向小切口进胸。切除肺叶从小切口取消。常规清扫淋巴结。结果行右肺上叶切除7例（其中2例为袖状切除），右肺中叶切除2例，有肺下叶切除5例，左肺上叶切除8例，左肺下叶切除12例。手术时间65-220min，平均（105±28）min，术中出血100～450ml，平均（190±55）ml，术后胸管总引流量240～650ml，平均（360±110）ml。术后1例出现右股动脉血栓。术后住院时间6-9天。术后随访2～60月，2例失访，因肿瘤复发或转移死亡10例。结论电视胸腔镜辅助小切口行肺癌根治术是一种安全可行的手术方法，是全胸腔镜手术及常规开胸手术的扩展，有其一定的适应症。

Analysis to 34 cases of video-assisted mini-thoracotomy for radical resection of lung carcinoma

Objective To assesss the value of video-assisted mini-thoracotomy for radical resection of lung carcinoma. Methods From July 2004 to July 2009,34cases of radical resection of lung carcinomo were operated by video-assisted mini-thoracotomy.Of the patients,2 cases were in stage ⅠA,2 cases in stage ⅠB, 11 cases in stage Ⅱ A,13 cases in stage Ⅱ B and 6 cases in stage Ⅲ A. 27 cases were peripheral lung cancer and 7 cases central cancer. Under general anesthesia,double-lumen endotracheal intubation is achieved. One access port for the insertion of a thoracoscope is placed with a 2.0cm -long incision in the eighth or ninth intercostal space over the midaxillary line. An additional transverse skin incision 4.0 to 10.0cm long for access thoracotomy is made over the midaxillary line in the fourth or fifth interspace.The rsected lobe is removed through the mini-incision. Lymph nodes are dissected routinely.Results Upper right lobectomy was carried out in 7 patients(including 2 cases of sleeve lobectomy),right middle lobectomy 2 cases,lower right lobectomy 5 cases,upper left lobectomy 8 cases and lower left lobectomy 12 cases.The mean operation time was 65～220min(105 ± 28)min].The mean blood loss in operation was 100～450 ml(190 ± 55)ml]. Postoperatinely,the chest drainage was 240～650 ml (360 ± 110)ml] and thrombus of right femoral occurred in 1 case.The patients were discharged from the hospital in 6～9 days after the surgery and followed up for 2～60 months .Of these patients 2 patients lost following up and 10 cases died in cancer recurrence or metastasis. Conclusions Video-assisted mini-thoracotomy for radical resection of lung carcinoma is a feasible and safe procedure,is to expand the appropriate use of VATS lobectomy and conventional lobectomy and has some indications.