电视胸腔镜手术诊断和治疗高龄小结节非小细胞肺癌

目的探讨电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)诊治高龄小结节非小细胞肺癌(small nodules non-small cell lung cancer,snNSCLC)的价值。方法 2008年1月～2011年6月32例(71～85岁)snNSCLC术前CT引导下带钩钢丝体表定位,经电视胸腔镜应用内镜缝合切割器切除病灶,术中快速冰冻切片明确诊断,行肺段切除术,肺叶切除术,或距肿瘤边缘1.5 cm行楔形切除术。结果手术时间(185.5±34.6)min;术中出血量(90.6±58.3)ml。切除淋巴结(7.8±3.8)枚。术中诊断皆为原发性肺癌。无术中死亡,术后肺部感染3例,肺不张4例,心房纤颤1例,皆经治疗后痊愈。胸腔引流(2.2±1.6)d,引流量(226.8±48.5)ml/d。术后病理:鳞癌5例,腺癌27例;T1aN0M028例,T1aN1M04例。住院时间(8.6±2.7)d。31例随访2～42个月,中位随访时间21.5月,26例无瘤生存,5例术后6～20个月发生转移或复发,其中胸膜转移1例,脑转移1例,骨转移1例,肺内转移2例。结论 VATS诊治高龄snNSCLC能最大限度保留健康肺组织,安全、可行。

Video-assisted Thoracoscopic Surgery for the Diagnosis and Treatment of Small-nodule Non-small Cell Lung Cancer in Elderly Patients

Objective To evaluate the efficacy of video-assisted thoracoscopic surgery(VATS) for diagnosis and treatment of small-nodule non-small cell lung cancer(snNSCLC) in elderly patients.Methods Under CT guidance,hookwire was used preoperatively to localize snNSCLC in 32 patients(71-85 years old) from January 2008 to June 2011,and then segmentectomy,lobectomy,or wedge resection(1.5 cm from the tumor edge) was performed by VATS based on fast frozen sections.Results The procedure was completed in(185.5±34.6)min,and the mean blood loss was(90.6±58.3)ml.A mean of(7.8±3.8) lymph nodes were resected during the operation.All the patients were diagnosed with primary lung cancer.None of them died during the procedure.After the surgery,3 patients developed pulmonary infection,4 had atelectasis,and one showed atrial fibrillation,all of them were cured.The mean duration for chest drainage was(2.2±1.6)d;and the mean drainage volume was(226.8±48.5)ml/d.Postoperative pathology showed squamous cell cancer in 5 cases and adenocarcinoma in 27;28 of the cases were in T1aN0M0,and 4 were in T1aN1M0.The mean hospital stay was(8.6±2.7)d.Among the 32 cases,follow-up was achieved in 31 of them for 2 to 42 months with a medium of 21.5 months,during which 26 patients survived without tumor,5 patients showed metastasis or recurrent tumor in 6-20 months(pleural metastasis in one case,brain metastasis in one,bone metastasis in one,and pulmonary metastasis in 2).Conclusion VATS is feasible and safe for diagnosis of snNSCLC in elderly patients with the healthy lung tissues been retained to the utmost.