CAJ | 학술논문

目的：总结预防及处理胸腔镜肺叶切除术中并发症的方法。方法：2007年1月至2012年12月，实施VATS肺叶切除手术317例。观察术中并发症的发生情况并总结处理对策。结果：术中发生并发症患者28例（8.8％），包括血管意外损伤出血16例（5.0%）、误伤/断支气管2例（0.6%）、缝合器切割血管残端渗血4例（1.3%）、缝合器切割残端肺漏气3例（0.9%）、肺损伤2例（0.6%）、膈肌损伤1例（0.3%）。中转开胸17例，中转率5.4%。出血镜下修补成功14例，成功率70%（14/20）。术中无死亡病例。结论：胸腔镜肺叶切除是胸外科难度较高的手术方法，需注重预防及正确处理术中并发症，尤其是大血管的损伤出血，才能减少中转开胸率及术后并发症的发生率，使其得到广泛的推广。
목적：총결예방급처리흉강경폐협절제술중병발증적방법。방법：2007년1월지2012년12월，실시VATS폐협절제수술317례。관찰술중병발증적발생정황병총결처리대책。결과：술중발생병발증환자28례（8.8％），포괄혈관의외손상출혈16례（5.0%）、오상/단지기관2례（0.6%）、봉합기절할혈관잔단삼혈4례（1.3%）、봉합기절할잔단폐루기3례（0.9%）、폐손상2례（0.6%）、격기손상1례（0.3%）。중전개흉17례，중전솔5.4%。출혈경하수보성공14례，성공솔70%（14/20）。술중무사망병례。결론：흉강경폐협절제시흉외과난도교고적수술방법，수주중예방급정학처리술중병발증，우기시대혈관적손상출혈，재능감소중전개흉솔급술후병발증적발생솔，사기득도엄범적추엄。
Objective: To summarize the methods of preventing and managing the complications in thoracoscopic lobectomy. Methods:The participants of this study included 317 patients undergoing lobectomy with video-assisted thoracoscopic surgery in the Department of Thoracic Surgery between January 2007 and December 2012. Intra-operative complications were observed, and countermeasures were summarized. Results: Complications occurred 28 times (8.8%), including bleeding in 16 cases because of accidental vascular injury (5.0%), accidental injury/break of bronchus in two cases (0.6%), vascular stump errhysis from cutting stapler in four cases (1.3%), lung stump air leakage in three cases (0.9%), lung injury in two cases (0.6%), and diaphragmatic injury in one case (0.3%). Conversion to thoracotomy was conducted in 17 cases, with a conversion rate of 5.4%. Thoracoscopic repair operation was performed in 14 cases that exhibited bleeding, with a success rate of 70% (14/20). No mortality was reported during the operation. Conclusion:Thoracoscopic lobectomy is a highly difficult method in thoracic surgeries. The procedure requires substantial attention on the timely prevention and correct management of intra-operative complications, particularly the injury and bleeding of major vessels, to reduce the rate of conversion to thoracotomy and the incidence of post-operative complications, as well as to promote the surgery in clinics.