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目的:探讨微创肌肉非损伤性开胸术(Muscle-Sparing thoracotomy,MST)气道和(或)血管重建治疗中心型非小细胞肺癌(non-small cell lung cancer,NSCLC)的可行性及临床效果。方法:本组共27例,其中,鳞癌14例,腺鳞癌5例,腺癌7例,黏液表皮样癌1例;ⅡB期9例,ⅢA期12例,ⅢB期6例。均采用左或右胸前外侧MST,长9～15cm。主要手术方式包括:右上叶袖状切除7例,其中3例同时行肺动脉袖状切除;右下叶袖状切除2例;左上叶袖状切除9例,其中,4例同时行肺动脉袖状切除术,2例同时行肺动脉楔形切除术;左下叶袖状切除3例;右肺中上叶袖状切除2例;右肺中下叶袖状切除2例;隆凸切除成形2例。结果:MST能充分暴露术野,全部病例没有输血。26例患者为完全性切除(R0),1例为不完全性切除(R1)。术后发生胸腔积液1例,心律失常2例,无支气管胸膜瘘发生,无围术期死亡病例。术后住院天数为9～14d。结论:采用MST对局部晚期NSCLC行气道和(或)血管重建,可取得较满意的临床效果。术中需要采用单手及加长器械操作,必要时采用头灯或冷光源协助照明。
Objective: To investigate the feasibility and clinical efficacy of Muscle-Sparing thoracotomy (MST) airway and / or revascularization in the treatment of non-small cell lung cancer (NSCLC) effect. Methods: A total of 27 cases were included in this study. Among them, 14 were squamous cell carcinoma, 5 adenosquamous carcinoma, 7 adenocarcinoma and 1 mucoepidermoid carcinoma. There were 9 cases of stage ⅡB, 12 cases of stage ⅢA and 6 cases of stage ⅢB. All left or right thoracic lateral MST, length 9 ~ 15cm. The main surgical methods include: the right upper lobe sleeve resection in 7 cases, of which 3 cases of simultaneous removal of the pulmonary artery sleeve; right lower lobe sleeve resection in 2 cases; left upper lobe sleeve resection in 9 cases, of which 4 cases concurrently pulmonary sleeve sleeve resection The other 2 cases underwent pulmonary artery wedge resection. There were 3 cases of left lower lobe sleeve resection, 2 cases of right middle lobe sleeve resection and 2 cases of middle and lower lobe of right lung sleeve excision. Results: MST was able to fully expose the operative field and no blood transfusion in all cases. Twenty-six patients had complete resection (R0) and one had incomplete resection (R1). Postoperative pleural effusion in 1 case, arrhythmia in 2 cases, no bronchopleural fistula occurred, no perioperative deaths. Postoperative hospital days for 9 ~ 14d. Conclusion: MST can be used to treat airway and / or revascularization in locally advanced NSCLC. Satisfactory clinical results can be obtained. Intraoperative need to use one hand and extended equipment operation, if necessary, headlights or cold light to assist lighting.