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全胸腔镜肺叶切除术治疗肺良性疾病

Video-assisted thoracoscopic lobectomy for benign pulmonary diseases

摘要:

目的:探讨肺良性疾病全胸腔镜肺叶切除手术的特点.方法:2006年9月至2008年9月,24例肺部良性病变患者接受25例次胸腔镜肺叶切除手术(1例为同期双侧手术).其中男性11例,女性13例,平均年龄49.0岁.全组患者中9例为影像学占位病变,于术中明确病理学诊断;另外15例为良性疾病择期手术,包括支气管扩张10例.手术中对胸膜腔致密粘连、肺动脉周围粘连、钙化淋巴结、支气管动脉扩张迂曲等慢性炎性改变依情况处理.术后平均随访7.3个月.结果:25例次胸腔镜肺叶切除术包括左上叶切除术3例,左肺下叶切除术9例,右肺上叶切除术2例,右肺中叶切除术4例,右肺下叶切除术7例.各种炎性粘连均成功在镜下进行处理,手术无中转开胸.手术时间(163±52)min,术中出血量(163±130)ml.无围手术期死亡及严重并发症,平均胸腔引流时间(5.8±2.8)d.随访中未发生远期并发症.结论:炎症粘连是造成肺良性疾病胸腔镜肺叶切除手术困难的主要原因.胸腔镜手术可应用于绝大部分良性疾病肺叶切除.

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abstracts:

Objective To evaluate technique aspects of video-assisted thoracoscopic lobectomy for benign diseases. Methods Retrospective review of 24 patients with benign pulmonary disease underwent thoracoscopic lobectomy from September 2006 to September 2008. One patient had bilateral bronchiectasis received concurrent bilateral lobectomy. The patients included 11 males and 13 females with mean age of 49.0 years. Fifteen cases were diagnosed as benign diseases preoperatively consisted 10 branchoactasis as the primary indication. The other 9 cases were pulmonary nodules pathologic diagnosed intra-operatively. Inflammation changes including dense plural adhesions, pulmonary artery adhesions and calcified lymph nodes were managed endoscopically. Results All 25 thoracoscopic procedures were completely with no conversion to thoracotomy. The mean operation time was (163±52) min, blood loss was (163 ± 130) ml. There was no hospital death or major morbidity. Postoperative drainage was (5.8±2.8) d. No long-term complications were noticed during a mean follow-up of 7.3 months. Conclusion Chronic inflammation induced adhesions is the key limiting factor for thoracoscopic lobectomy for benign diseases.

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作者: 杨帆 [1] 李运 [1] 刘军 [1] 李剑锋 [1] 姜冠潮 [1] 赵辉 [1] 王俊 [1]
第一作者: 杨帆
期刊: 《中华外科杂志》2009年47卷6期 454-456页 MEDLINEISTICPKUCSCD
分类号: R6
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2009.06.017
发布时间: 2009-05-12
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