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目的 :探讨电视胸腔镜对肺癌切除及肺门、纵隔淋巴结清扫的可行性、手术适应证并介绍手术操作方法。方法 :1 997年 9月～ 2 0 0 1年 1 1月 ,我院经胸腔镜行肺癌根治术 67例 ,Ⅰ期 36例、Ⅱ期 2 5例、Ⅲa期 6例。行右上肺叶切除 1 7例 ,右中肺叶切除 5例 ,右下肺叶切除 1 0例 ,左上肺叶切除 1 6例 ,左下肺叶切除 8例 ,右中上肺叶切除 3例 ,右中下肺叶切除 4例 ,左全肺切除 4例。术后Ⅱ～Ⅲa期肺癌辅以化疗或放疗等综合治疗。结果 :术中除 2例因胸膜与肺广泛致密粘连转传统开胸手术外 ,其余病例都顺利完成手术 ,术中清扫淋巴结757个 ,平均 1 1 .3个 /例 ,病理证实有淋巴结转移者 31例。手术平均时间 1 86min ,平均拔胸腔引流管时间53h ,术后平均住院时间 9.5d。术后发生并发症 4例 ,均治愈。术后随访 50个月 ,其 1 ,3年总的生存率分别为1 0 0 %和 70 .1 %。结论 :电视胸腔镜对肺癌根治术 ,只要严格掌握手术适应证 ,合理利用胸壁小切口操作技术 ,该技术是安全的 ,对肺门及纵隔淋巴结清扫也是可行的 ,能达到与传统开胸肺癌根治同等治疗目的
Objective : To explore the feasibility of video-assisted thoracoscopic surgery for lung cancer resection and hilar and mediastinal lymph node dissection, and indications for surgical operation. METHODS: From September 997 to January 2001, 67 patients with lung cancer underwent thoracoscopic surgery in our hospital. 36 patients in stage I, 25 in stage II, and 6 in stage IIIa. Right upper lobe resection was performed in 17 cases, right middle lobe resection in 5 cases, right lower lobe resection in 10 cases, left upper lobe resection in 16 cases, left lower lobe resection in 8 cases, right upper lobe resection in 3 cases, and right middle lobe lobe resection in 4 cases. Cases, left pneumonectomy in 4 cases. Postoperative stage II-IIIa lung cancer supplemented by chemotherapy or radiotherapy and other comprehensive treatment. RESULTS: In addition to 2 cases of extensive thoracolumbar and lung thoracic surgery and conventional thoracotomy, all other cases successfully completed the operation. During the operation, 757 lymph nodes were removed, with an average of 113 cases/case. Pathologically confirmed lymph node metastasis 31 cases. The average time of operation was 186 minutes, and the average length of drainage tube was 53 hours. The average hospital stay was 9.5 days. Postoperative complications occurred in 4 patients and all were cured. After a follow-up of 50 months, the overall 1-year and 3-year survival rates were 100% and 70.1%, respectively. Conclusion: For video-assisted thoracoscopic surgery for lung cancer, as long as it strictly controls the surgical indications and reasonably uses the chest wall small incision operation technique, the technique is safe and it is feasible for dissection of hilar and mediastinal lymph nodes. The same purpose of treatment