胸腔镜手术在孤立性肺结节诊断和治疗中的应用

目的探讨胸腔镜手术在孤立性肺结节诊断和治疗中的价值。方法1994年5月～2009年11月,经胸片、胸部CT发现的周围型孤立性肺结节(直径≤3cm)115例,术前均无明确病理诊断,经胸腔镜手术局部切除,术中送快速冰冻病理检查,根据病理结果和病人情况决定手术方式。原发性肺癌行全胸腔镜或胸腔镜辅助小切口肺叶切除、淋巴结清扫40例;行肺楔形切除75例,其中良性肿瘤59例、转移癌11例、不适合肺叶切除的原发性肺癌5例。结果所有病人均明确病理诊断,确诊率100%。术中、术后并发症10例(8.7%,10/115):全胸腔镜肺叶切除术中肺动脉分支出血1例,转小切口开胸止血;胸引管拔除超过1周3例,呼吸功能不全3例,肺不张、胸腔积液、切口感染各1例,经对症治疗治愈。无严重手术并发症,无手术死亡。良性肿瘤59例随访2～176个月,平均44.5月,无复发。原发性肺癌行全胸腔镜肺叶切除、淋巴结清扫18例,随访3～24个月,平均11个月,1例24个月复发仍存活,其余无复发。结论胸腔镜手术在明确孤立性肺结节病理诊断方面有不可取代的重要作用。良性孤立性肺结节得到治愈,原发肺癌可以得到明确诊断,及时有效的治疗,微创效果显著。

Video-assisted Thoracoscopis Surgery for the Diagnosis and Treatment of Solitary Pulmonary Nodule

Objective To discuss the value of video-assisted thoracoscopic surgery（VATS）in the diagnosis and treatment of solitary pulmonary nodule（SPN）.Methods From May 1994 to November 2009,115 cases with SPN（≤3 cm in diameter）discovered by CT scan and X-ray but without preoperative pathologic diagnosis were enrolled in this study.All the patients underwent wedge resection by VATS and then diagnosis was established by rapid pathology frozen section.The type of operation depended on the pathology and the condition of the patients.Forty cases,who had primary lung cancer underwent lobectomy and radical resection of the lymph nodes by completely thoracospic lobectomy or video-assisted thoracospic mini-invasive lobectomy.Pulmonary wedge resection was performed on 75 cases including 59 cases with benign nodule,11 cases with metastatic nodule and 5 cases with primary lung cancer for which lobectomy was not fit.Results Definite pathological diagnosis was made in all the patients and the diagnostic rate was 100%.Ten of the cases（10/115,8.7%）had complications during or after the operation.One of the cases who were treated by complete thoracoscopic lobectomy was converted to open thoracotomy with mini-invasive incision because of hemorrhage from a branch of the lung artery.The insertion time of chest tube was over 1 week in 3 cases and respiratory dysfunction was seen in 3 cases.Atelectasis,pleural hydrosis and wound infection was respectively found in one case but was all cured afterwards.No severe postoperative complications or perioperative death occurred.The mean follow-up time was 44.5 months（ranged from 2 to 176）in patients with benign tumor,and was 11 months（ranged from 3 to 24）in 18 patients with primary cancer who underwent lobectomy and radically resection of the lymph nodes by complete thoracoscopic lobectomy;only one recurrent case was found after 24 months.This patient is survived.Conclusions VATS is irreplaceable for definite pathologic diagnosis of SPN.By using the method,patients with benign SPN can be cured and those who have primary lung cancer can get definite diagnosis and effective treatment in time.