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目的探讨电视胸腔镜在肺癌根治及姑息性手术治疗中的作用。方法2003年6月至2007年6月笔者采用电视胸腔镜手术(VATS)治疗肺癌患者27例。IA期5例,IB期8例,ⅡA期2例,ⅡB期4例,ⅢA期2例,T4-ⅢB期3例,Ⅳ期3例。ⅢA期术期前临床评估为N0,术后病理查见N2转移。ⅢB期病例中2例为胸腔种植转移伴恶性胸水,1例为术中发现胸腔种植转移。Ⅳ期病例中1例为孤立脑转移瘤切除术后;2例为对侧或同侧肺孤立性转移。主要手术方式:肺叶切除23例,肺楔形切除4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20例。结果无围术期死亡,无支气管胸膜瘘发生,肺癌感染1例,切口液化1例。2例恶性胸水皆得到控制,分别术后6个月、8个月死亡。其余患者目前仍存活。外科术后住院8~15 d,平均9.6 d。结论胸腔镜手术适合早期肺癌的根治性手术治疗,对偶然性N2肺癌手术中纵隔需同期双侧手术者胸腔镜具有显著优势;对恶性胸水的姑息治疗能明显提高患者生存质量。
Objective To investigate the role of video-assisted thoracoscopy in the treatment of lung cancer and palliative surgery. Methods From June 2003 to June 2007, the authors used 27 cases of patients with lung cancer underwent video-assisted thoracoscopic surgery (VATS). 5 cases in stage IA, 8 cases in stage IB, 2 cases in stage IIA, 4 cases in stage IIB, 2 cases in stage IIIA, 3 cases in stage T4-IIIB and 3 cases in stage IV. The clinical evaluation of stage ⅢA preoperative N0, postoperative pathology check N2 metastasis. Two cases of stage ⅢB were pleural metastasis with malignant pleural effusion, and one case was pleural implant metastasis. One case of stage Ⅳ was isolated solitary brain metastases; two cases were solitary or ipsilateral lung solitary metastases. The main surgical methods: lobectomy in 23 cases, 4 cases of pulmonary wedge resection. Among them, 2 cases were performed wedge resection of solitary pulmonary metastases on the opposite side; the pleural implant nodules were resected, cauterization and pleural adhesions in malignant pleural effusion. Mediastinal lymph node dissection in 20 cases. Results There were no perioperative deaths, no bronchopleural fistula, 1 lung cancer infection and 1 incision liquefaction. 2 cases of malignant pleural effusion were controlled, respectively, 6 months after surgery, 8 months died. The remaining patients are still alive. Surgery after hospitalization 8 ~ 15 d, an average of 9.6 d. Conclusions Video-assisted thoracoscopic surgery is suitable for the radical surgical treatment of early-stage lung cancer. For occasional N2 lung cancer surgery, mediastinoscopy requires simultaneous bilateral thoracoscopic surgery. The palliative treatment of malignant pleural effusion can significantly improve the quality of life of patients.