胸腔镜下肺叶切除术治疗体会

目的：探讨胸腔镜下肺叶切除术治疗体会，分析顺利完成胸腔镜下肺叶切除术以及中转开胸的主要影响因素，以更好地把握全胸腔镜手术的适应证及中转开胸的时机。方法：选取本院2006年12月-2013年10月间进行的全胸腔镜肺叶切除术37例患者，其中全腔镜21例，16例中转行腔镜辅助小切口手术，比较中转行腔镜辅助小切口手术以及未中转的临床资料以及分析中转患者的主要原因。结果：术中中转行腔镜辅助小切口手术的主要原因有血管损伤（肺动脉损伤、肺静脉损伤、奇静脉损伤）、淋巴结干扰以及胸腔内的致密粘连等，其中肺动脉损伤是最为多见的原因，占37.50%（6/16），中转行腔镜辅助小切口手术组与未中转组年龄比较差异有统计学意义（P〈0.05），肿瘤直径比较差异无统计学意义（P〉0.05）。结论：血管损伤出血以及淋巴结的干扰、胸腔粘连是术中中转的主要原因，肿瘤大小不是常见的中转行腔镜辅助小切口手术的原因，而患者的年龄也会对中转开胸形成影响。

Experience of Lung Resection Via Thoracoscope Treatment

Objective：To study the experience of lung resection via thoracoscope treatment,to analyze the main influence factors of completely thoracoscope lung resection and transit thoracotomy ,in order to better grasp the indications of thoracoscope surgery and the timing of transfer thoracotomyion.Method：37 patients who received total thoracoscope lung resection surgery in our hospital from December 2006 to October 2013 were selected,of which 21 cases was all of cavity mirrors,16 cases of transit small assisted incision surgery improperness,study the clinical data of them and analysis the main causes of transfer improperness.Result：Vascular injury（pulmonary injury,pulmonary vein injury,azygos vein injury）,lymph node interference and chest cavity adhesion were the main reasons of transit assisted small mirror incision surgery intraoperative,among them the reason of the pulmonary artery injury was most common, accounting for 37.50%（6/16）,the difference of age of transit assisted small mirror incision surgery group,compared with no transshipment was statistically significant（P〈0.05）,the tumor diameter had no statistical difference（P〉0.05）. Conclusion：The vascular injury bleeding and the interference of lymph nodes,pleural adhesion are the major causes of intraoperative transit,tumor size is not a common cause,the patient＇s age will also influence it.