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目的探讨全胸腔镜解剖性肺段切除术治疗早期肺癌、肺转移瘤和肺良性疾病的可行性。方法 2011年1月~2016年1月我院行VATS肺段切除术30例,采用全胸腔镜三切口,用推结器丝线结扎或钛夹夹闭肺段动、静脉,切割缝合器闭合切断支气管,恶性肿瘤最后系统清扫区域淋巴结。结果 30例成功施行全胸腔镜解剖性肺段切除术,无中转开胸,其中切除左上肺舌段8例、尖前段1例、左下肺背段9例、基底段2例、右下肺基底段1例、背段9例,无围术期死亡。术后病理:ⅠA期肺癌20例,肺转移瘤2例,肺良性疾病8例(其中肺结核4例,支气管扩张2例,炎性假瘤2例)。ⅠA期肺癌手术时间(151.2±31.3)min,术中出血量(139.5±102.4)ml,术后拔胸管时间(4.6±1.3)d,术后住院时间(5.3±1.4)d。肺良性疾病手术时间(143.2±38.3)min,术中出血量(132.5±102.6)ml,术后拔胸管时间(4.1±1.4)d,术后住院时间(5.2±1.3)d。1例结肠癌肺转移手术时间150 min,术中出血量136 ml,术后拔胸管时间5 d,术后住院时间6 d。1例直肠癌肺转移手术时间141 min,术中出血量128 ml,术后拔胸管时间4 d,术后住院时间5 d。30例术后随访3~12个月,平均7.1月,均无复发及死亡。结论 VATS解剖性肺段切除术安全可靠,在最大限度保留肺功能的前提下应用于ⅠA期肺癌、不易行肺楔形切除术的肺转移瘤和肺良性疾病患者,尤其适用于老年低肺功能患者,适合临床推广应用。
Objective To investigate the feasibility of total thoracoscopic anatomic segmentectomy for the treatment of early stage lung cancer, lung metastases and benign lung diseases. Methods From January 2011 to January 2016, 30 patients underwent VATS segmentectomy in our hospital. Thoracotomy was performed using three thoracotomy incisions. Clots and veins were closed with wire knot pliers or titanium clips to close the pulmonary segment. Bronchial, Malignancies Last System Clears regional lymph nodes. Results Thirty patients underwent successful thoracoscopic dissection and thoracotomy without conversion to thoracotomy. There were 8 cases in the upper left lung segment, 1 in the anterior segment, 9 in the left lower lung, 2 in the basal segment, 1 case, 9 cases of back, no perioperative death. Postoperative pathology: 20 cases of stage IA lung cancer, 2 cases of lung metastases, 8 cases of benign lung disease (including 4 cases of pulmonary tuberculosis, bronchiectasis in 2 cases, inflammatory pseudotumor in 2 cases). The operation time of stage ⅠA lung cancer was (151.2 ± 31.3) min, the amount of intraoperative blood loss was (139.5 ± 102.4) ml, the time of pulling chest tube was 4.6 ± 1.3 days and the postoperative hospital stay was (5.3 ± 1.4) days. The operative time of pulmonary benign disease was (143.2 ± 38.3) min, the amount of bleeding during operation was (132.5 ± 102.6) ml, the duration of chest pulling after operation was (4.1 ± 1.4) days and the postoperative hospital stay was (5.2 ± 1.3) days. One case of colon cancer lung metastasis operation time 150 min, intraoperative blood loss 136 ml, postoperative pull chest tube time 5 d, postoperative hospital stay 6 d. A case of rectal cancer with lung metastasis was performed for 141 min, blood loss 128 ml, chest pullout time 4 days and postoperative hospital stay 5 days. 30 patients were followed up for 3 to 12 months, an average of 7.1 months, no recurrence and death. Conclusions VATS anatomic segmentectomy is safe and reliable and can be used in patients with stage IA lung cancer, pulmonary metastases and pulmonary benign diseases who are not easy to undergo pulmonary wedge resection, and is especially suitable for elderly patients with low pulmonary function , Suitable for clinical application.