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目的 探讨电视胸腔镜在肺癌完全性及姑息性手术治疗中的作用。方法 2 0 0 2年 2月至 2 0 0 3年 8月采用电视辅助胸腔镜手术 (VATS)治疗肺癌 43例。其中ⅠA期 5例 ,ⅠB期 14例 ,ⅡA期 1例 ,ⅡB期4例 ,ⅢA期 7例 ,T4 ⅢB期 6例 ,Ⅳ期 6例。ⅢA期术前临床评估为N0 ,术后病理查见N2 转移。ⅢB期病例中 3例为恶性胸水 ,3例为术中发现胸腔种植转移。Ⅳ期病例中 2例为晚期肺癌伴恶性心包积液 ,心脏压塞 ;1例为孤立脑转移瘤切除术后 ;3例为对侧或同侧肺孤立性转移。主要手术方式 :肺叶切除 3 6例 ,肺楔形切除5例 ,心包开窗 2例。其中 2例同期行对侧孤立性肺转移瘤楔形切除 ;恶性胸水行胸膜种植结节切除、烧灼 ,胸膜粘连术。行纵隔淋巴结清扫 3 6例。结果 无围术期死亡 ,无支气管胸膜瘘发生 ,肺部感染 5例 ,切口液化 2例。 3例恶性胸水均得到控制。 2例心包开窗引流患者分别于术后 4个月、8个月死亡。其余患者目前仍存活。除 2例心包开窗引流患者 ,外科术后住院时间为 5～ 15天 ,平均 7.4天。结论 VATS适合早期肺癌的完全性切除手术治疗 ,对偶然性N2 肺癌手术中行纵隔淋巴结清扫是可行的。对肺癌需同期双侧开胸手术者VATS具有显著优势。VATS对恶性胸水、心包压塞的姑息性治疗能明显提高患者生活质量
Objective To investigate the role of video-assisted thoracoscopy in complete lung cancer and palliative surgery. Methods From February 2002 to August 2003, 43 patients with lung cancer were treated with video-assisted thoracoscopic surgery (VATS). There were 5 cases of stage IA, 14 cases of stage IB, 1 case of stage IIA, 4 cases of stage IIB, 7 cases of stage IIIA, 6 cases of stage IVIB, and 6 cases of stage IV. Preoperative clinical evaluation of stage Ⅲ A N0, postoperative pathological examination see N2 metastasis. Three cases of stage ⅢB were malignant hydrothorax, and three cases were found to have pleural implant metastasis during operation. Two cases of stage Ⅳ were advanced lung cancer with malignant pericardial effusion and cardiac tamponade. One case had solitary brain metastases resection and three cases had contralateral or ipsilateral pulmonary solitary metastases. The main surgical methods: lobectomy 36, wedge resection in 5 cases, 2 cases of pericardial fenestration. Among them, 2 cases were performed wedge resection of solitary pulmonary metastases on the opposite side; the pleural implant nodules were removed, cauterization and pleural adhesions in malignant pleural effusion. 36 cases of mediastinal lymph node dissection. Results no perioperative deaths, no bronchopleural fistula occurred, 5 cases of lung infection, incision liquefaction in 2 cases. Three cases of malignant pleural effusion were controlled. 2 cases of pericardial fenestration patients were killed after 4 months, 8 months. The remaining patients are still alive. In addition to 2 cases of pericardial fenestration patients, surgical postoperative hospital stay for 5 to 15 days, an average of 7.4 days. Conclusions VATS is suitable for complete resection of early lung cancer. It is feasible to dissect mediastinal lymph nodes in patients with incidental N2 lung cancer. VATS has the obvious advantage for patients with lung cancer requiring bilateral thoracotomy. VATS of malignant pleural effusion, tamponade palliative treatment can significantly improve the quality of life of patients