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目的探讨电视胸腔镜辅助小切口(VAMT)肺叶切除术在周围型肺癌及肺周围型病变治疗中的应用价值。方法对454例周围型肺癌及肺周围型病变在全麻下实施VAMT肺叶切除、淋巴结清扫术或肺叶切除术,所有患者均行全麻双腔气管插管单肺通气,肺癌患者常规行系统淋巴结清除。结果本组454例中,肺癌371例,肺良性病变83例,手术时间90～265min,术中出血量50～450ml,术后胸引管带管时间5～11d,术后住院时间5～13d。53例出现术后并发症;肺癌患者行纵隔淋巴结清扫9～35枚/例,围术期死亡1例(因呼吸衰竭死亡)。随访满5年者298例,总的5年生存率:Ⅰ期89.3%,Ⅱ期46.0%,Ⅲ期22.6%。结论 VAMT对周围型肺癌及肺周围型病变是一种安全可行的手术方法,可达到与常规开胸手术相同的外科治疗效果。
Objective To investigate the value of video-assisted thoracoscopic assisted small incision (VAMT) lobectomy in the treatment of peripheral lung cancer and peripheral lung lesions. Methods 454 cases of peripheral lung cancer and peripheral pulmonary lesion under general anesthesia were performed VAMT lobectomy, lymph node dissection or lobectomy, all patients underwent general anesthesia double lumen endotracheal intubation single lung ventilation, lung cancer patients with conventional systemic lymph node Clear. Results Among the 454 cases, 371 cases of lung cancer and 83 cases of benign lung disease were treated in this study. The operative time ranged from 90 to 265 minutes. The intraoperative blood loss was 50 to 450ml. The postoperative thoracic tube lap time was 5 to 11 days. The postoperative hospital stay was 5 to 13 days . 53 patients had postoperative complications; patients with lung cancer underwent mediastinal lymph node dissection of 9 to 35 cases / perioperative death in 1 case (due to respiratory failure death). 298 cases were followed up for 5 years. The overall 5-year survival rate was 89.3% in stage Ⅰ, 46.0% in stage Ⅱ and 22.6% in stage Ⅲ. Conclusions VAMT is a safe and feasible surgical method for peripheral lung cancer and peripheral pulmonary disease, and can achieve the same surgical treatment effect as conventional thoracotomy.