胸腔镜辅助小切口下根治性肺癌切除术的临床研究

目的:旨在探讨胸腔镜辅助小切口下(VAMT)根治性肺癌切除术的可行性。方法:电视胸腔镜辅助小切口下肺叶切除、淋巴结清扫术,随后将小切口延长为常规后外侧开胸切口,直视下淋巴结清扫。从2006年10月~2007年4月共进行该手术12例,将该部分病例作为VAMT组,组内比较两种手术方式清扫的淋巴结数及转移阳性的淋巴结数,并与同期20例常规开胸手术进行比较研究。结果:VAMT组12例肺癌患者共切除淋巴结138枚,其中VAMT切除134枚,阳性淋巴结49枚。随后常规开胸共切除4枚。组内比较两种术式淋巴结总数和阳性淋巴结数无显著差异。与传统手术比较,VAMT在手术时间、术后拔管时间和淋巴结清扫数量无显著差异;术中出血量、术后住院天数VAMT组明显优于传统组。结论:对于早期肺癌,VAMT淋巴结清扫可取得和常规开胸相当的效果,且出血少,疼痛轻,术后恢复快,为肺叶或全肺切除、淋巴结清扫提供了一种可供选择的方法。

Clinical Study of Video-assisted Mini-thoractomy Surgery with Lymphadectomy for Lung Cancer

Objective:The study was to evaluate the feasibility of pulmonary resection by video-assisted mini-thoractomy(VAMT)for patients with lung cancer.Methods:From October 2006 to 2007,radical lobectomy or pneumonectomy and systemic lymphadenectomy were preformed on 12 patients with lung cancer through VAMT at first,and then lymphadenectomy were done again through routine thoractomy(VAMT group,n=12).The total lymphnodes and the metastatic lymphnodes were compared concerned with the different operative methods in the VAMT group.Meanwhile the comparison was also done between VAMT and conventional thoracotomy group(Conventional group,n=20).Results:A total of 138 lymph-nodes were removed on the 12 patients with lung cancer,134 within 49 positive lymph-nodes were resected by VAMT,other 4 lymph-nodes within 1 positive lymph-nodes were resected in later routine thoractomy,there was no significant difference in the total lymph-nodes and positive lymph-nodes between the two groups.There was also no significant difference with respect to the length of operation and the total number of dissected lymph nodes compared between the conventional thoracotomy and VAMT,but less operative blood loss and shorter postoperative hospitalization in VAMT.Conclusion:In early stage of lung cancer,the VAMT would provide the same quality lymphadenectomy in adjunct the definitive lung cancer resection with less blood loss,little pain,shorter postoperative recovery time.