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目的探讨全胸腔镜下支气管/肺动脉切除成形肺叶切除术的可行性及探索性适应证。方法 2016年4~6月对11例中央型肺癌行全胸腔镜下支气管/肺动脉切除成形肺叶切除及系统性淋巴结清扫术,其中3例行右肺上叶支气管袖式切除成形术,7例行右肺上叶支气管楔形切除成形术,1例行左肺上叶支气管楔形切除成形及左肺动脉干侧壁成形肺叶切除。均采用三孔法全胸腔镜下解剖性肺叶切除。支气管成形采用连续缝合法,经主操作孔吻合成形,肺动脉成形采用近远端阻断后,经主操作孔侧壁成形后加固。结果 11例均顺利完成肺叶切除,其中10例支气管切除成形重建,1例同时行肺动脉干成形,均行系统性淋巴结清扫。右肺上叶支气管楔形切除成形手术时间(切皮至缝皮,下同)210~300 min(中位时间240min),右肺上叶支气管袖式切除成形手术时间210~300 min(中位时间270 min),左肺上叶支气管楔形切除成形+肺动脉干侧壁切除成形手术时间260 min。支气管楔形切除吻合时间11~30 min,中位时间15 min;支气管袖式切除吻合时间25~74min,中位时间30 min;肺动脉侧壁成形15 min。术后无吻合口漏、出血、肺不张、肺部感染、刺激性咳嗽、咯血等并发症,无围手术期死亡。术后平均住院5.1 d(4~7 d)。术后病理:鳞癌9例,腺癌1例,神经内分泌癌1例。11例随访2~4个月,未见肿瘤复发转移征象。结论全胸腔镜支气管/肺动脉成形肺叶切除术治疗中央型肺癌安全可行,其探索性适应证为叶、段支气管开口且无明显肺门淋巴结钙化的中央型肺癌。
Objective To investigate the feasibility and exploratory indications of total thoracoscopic bronchial / pulmonary resection lobe excision. Methods From April to June 2016, 11 cases of central lung cancer underwent thoracoscopic resection and systemic lymphadenectomy with bronchial / pulmonary artery thoracotomy. Of them, 3 cases underwent upper thoracic bronchial sleeve resection and angioplasty in 7 cases Right upper lobe bronchial wedge resection and angioplasty, 1 case of left upper lobe bronchial wedge resection and left pulmonary artery wall resection lobectomy. All three-hole thoracoscopic anatomic lobectomy. Bronchoplasty by continuous suture method, the main operating hole anastomosis shape, pulmonary artery proximal and distal block by the formation of the main operation hole after the formation of the side wall reinforcement. Results All the 11 cases were successfully performed lobectomy. Among them, 10 cases were reconstructed with bronchoplasty and 1 case with pulmonary artery. All patients underwent lymphadenectomy. The right lung bronchial wedge resection and shaping operation time (cut to the skin, the same below) 210 ~ 300 min (median time 240min), the right upper lobe bronchial sleeve resection forming surgery time 210 ~ 300min (median time 270 min), left upper lobe bronchial wedge resection forming + pulmonary artery wall resection and shaping operation time 260 min. Bronchial wedge resection and anastomosis time of 11 to 30 min, the median time of 15 min; bronchial sleeve anastomosis time of 25 to 74 min, median time 30 min; pulmonary artery wall forming 15 min. No postoperative anastomotic leakage, bleeding, atelectasis, pulmonary infection, irritating cough, hemoptysis and other complications, no perioperative deaths. The average postoperative hospital stay was 5.1 days (range 4-7 days). Postoperative pathology: squamous cell carcinoma in 9 cases, adenocarcinoma in 1 case, neuroendocrine carcinoma in 1 case. 11 cases were followed up for 2 to 4 months, no signs of tumor recurrence and metastasis. Conclusions Thoracoscopic bronchial / pulmonary angioplasty lobectomy is safe and feasible for central lung cancer. The exploratory indications are central lung cancer with lobectomy and bronchial opening with no obvious hilar lymph node calcification.