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目的探讨胸腔镜袖式肺叶切除术治疗中央型肺癌的安全性、可行性。方法 2015年12月至2016年7月完成4例肺癌胸腔镜右肺上叶袖式切除术,均采用“三孔法”腔镜下行肺叶动脉、静脉、叶间裂切断,淋巴结系统性清扫,并袖式切除支气管。采用3-0滑线连续吻合,自支气管后壁开始,经主操作孔行支气管端端吻合术。结果 4例患者均顺利完成肺叶切除、支气管袖式切除吻合及系统性淋巴结清扫。手术时间180~400min,平均225min;支气管吻合时间45~75min,平均55min。术后无吻合口漏、肺不张、肺部感染等严重并发症,无围手术期死亡。1例患者术后第6天出现气胸、胸壁皮下气肿,行胸腔闭式引流术后治愈。4例患者随访1~7个月,均健在,无刺激性咳嗽、吻合口狭窄等并发症。结论胸腔镜袖式肺叶切除术治疗中央型肺癌安全、可行。
Objective To investigate the safety and feasibility of thoracoscopic sleeve lobectomy in the treatment of central lung cancer. Methods From December 2015 to July 2016, 4 cases of lung cancer undergoing thoracoscopic right lung lobectomy were performed. All of them underwent “three-hole” endoscopic descending lung arteries, veins, Sweep, and sleeve removal of the bronchus. Using 3-0 slide continuous anastomosis, since the beginning of the posterior wall of the bronchus, bronchial end of the main operation hole anastomosis. Results All 4 patients successfully completed lobectomy, bronchial sleeve anastomosis and systemic lymph node dissection. Operative time 180 ~ 400min, an average of 225min; bronchial anastomosis time 45 ~ 75min, an average of 55min. No postoperative anastomotic leakage, atelectasis, pulmonary infection and other serious complications, no perioperative deaths. One patient had pneumothorax and chest wall emphysema on the 6th day after operation, and was cured after thoracic closed drainage. Four patients were followed up for 1 to 7 months, were healthy, non-irritating cough, anastomotic stenosis and other complications. Conclusions Thoracoscopic sleeve lobectomy is safe and feasible for central lung cancer.