电视胸腔镜在肺部小结节诊治中的应用体会

目的:评价电视胸腔镜手术诊治肺部小结节的应用效果。方法:2009年3月至2013年4月为29例肺部孤立、多发小结节(直径<1 cm)患者行电视胸腔镜下肺部病变切除术,术中行快速病理检查,以明确诊断,指导下一步治疗方案。结果:手术均顺利完成,肺部结节的定位均在手指辅助下完成,未扩大切口。未发生围手术期死亡及严重并发症。单纯楔形切除术手术时间均<30 min(不包括病理等待时间),肺叶切除术手术时间45~70 min,出血量<100 ml。术中快速冰冻病理学检查报告原发性恶性肿瘤9例,腔镜下行肺叶切除术6例、肺段切除术3例,病理诊断分别为鳞状细胞癌、腺癌。继发性恶性肿瘤9例,良性病变11例。结论:电视胸腔镜技术诊断肺部小结节具有较大优势,可明确下一步治疗方案。胸腔镜肺部小结节楔形切除术既可明确诊断、及时治疗,又可避免误诊导致的不恰当用药,与传统诊疗方法相比优势明显。

Application of video-assisted thoracoscopy in diagnosis and treatment of lung small nodule

Objective：To assess the efficacy of video-assisted thoracoscopic surgery（VATS） in diagnosis and treatment of lung small nodule. Methods：Twenty-nine patients with solitary or multiple small nodule in lung（ less than 1 cm） were given VATS from Mar. 2009 to Apr. 2013. The nodules were removed during the operation,and rapid pathology was performed in order to definitive diagnosis. Results：All of the operations were successful. The location of lung nodules was assisted by fingers without expanding incision. No death or severe complications were found. Time of pulmonary wedge resection was less than 30 min,and that of lobectomy was 45-70 min. The blood loss was less than 100 ml. 9 cases were primary malignant tumors. 6 lobectomy of lung and 3 segmental resection of lung were performed. The rapid pathology were squamous carcinoma and adenocarcinoma. 9 of them were metastatic tumors and 11 were benign diseases. Appropriate treatment was performed based on the results of rapid pathology. Conclusions：VATS has great advantage in diagnosis and treatment of lung small nodule,and next treatment can be determined easily. Pulmonary wedge resection with VATS could be used for diagnosis and treatment,avoid medication errors caused by misdiagnosis,which is better than the conventional method.