当代医学
噹代醫學
당대의학
CHINA CONTEMPORARY MEDICINE
2013年
32期
1-4
,共4页
电视胸腔镜手术%肺段切除术%淋巴结清扫术%肺癌
電視胸腔鏡手術%肺段切除術%淋巴結清掃術%肺癌
전시흉강경수술%폐단절제술%림파결청소술%폐암
Video-assisted thoracic surgery%Pulmonary segment resection(or segmentectomy)%Lymph node dissection%Lung cancer
目的：通过对102例实施肺段切除术患者的临床回顾性分析，探讨全胸腔镜下肺段切除术的安全性和可行性。方法回顾性的分析了1997年10月-2012年7月，上海市肺科医院胸外科共实施全胸腔镜下肺段切除手术102例。其中全胸腔镜左肺上叶舌段20例（19.61%）、左肺上叶后段4例（3.92%）、左肺上叶尖后段5例（4.90%）、左肺上叶尖前后段5例（4.90%）、左肺上叶尖段1例（0.98%）、左肺上叶尖前段1例（0.98%）、左肺上叶前段3例（2.94%）、左肺上叶前后段1例（0.98%）、左肺上叶舌段+左肺下叶10例（9.80%）、左肺上叶后段+右肺下叶1例（0.98%）、左肺下叶前内基底段2例（1.96%）、左肺下叶背段6例（5.88%）、左肺下叶前基底段1例（0.98%）、右肺上叶后段14例（13.73%）、右肺上叶尖段3例（2.94%）、右肺上叶尖后段5例（4.90%）、右肺上叶尖前段1例(0.98%)、右肺上前段3例（2.94%）、右肺上叶后段+右肺下叶2例（1.96%）、右肺下叶背段10例（9.80%）、右肺下叶背段+中叶2例（1.96%）、右肺下叶背段+前基底段1例（0.98%）、右上后段+右下背段+左下背段+左肺下叶基底段1例（0.98%）。结果本组患者肺功能MVV为51.0～146.1 L/min，平均(93.8±20.9)L/min，中位数93.4 L/min；占64.0%～125.4%，平均(94.3±15.4)%，中位数96.0%。FEV 1为1.27～3.97 L，平均(2.68±0.7)L，中位数2.64 L；占52.0%～117.9%，平均(88.2±16.4)%，中位数85.6%。本组无手术死亡，无术后早期死亡(30 d内)。本组手术时间90～330 min，平均(168±55.1)min，中位数150 min；术中出血50～1800 mL，平均(275±402.8)mL，中位数150 mL；术中使用闭合钉数2～12枚，平均(5.5±2.0)枚，中位数5枚；占位大小0.3～7.5 cm，平均(2.6±1.6)cm，中位数2.5 cm。本组术后引流量100～900 mL，平均（300.87±91.95）mL，中位数275 mL；术后引流管置管时间2～12 d，平均（4.83±1.42）d，中位数4 d；术后住院天数3～15 d，平均（6.60±1.76）d，中位数6 d。1例中转小切口开胸，开胸原因均为胸内广泛粘连。本组1例患者术后并发乳糜胸，经治疗好转出院。本组术后病理诊断AHH 1例、肺泡上皮不典型腺瘤样增生3例、错构瘤4例、结缔组织增生1例、大细胞癌2例、结核肉芽肿8例、肺结核8例、肺囊肿3例、肺泡细胞癌9例、机化性肺炎3例、转移性腺癌3例、乳腺癌肺转移1例、鳞癌10例、腺癌22例、腺鳞癌1例、炎性实变4例、硬化性血管瘤3例、神经内分泌癌1例、肺脓肿1例、真菌性肉芽肿3例、支气管扩张10。结论全胸腔镜下实施肺段切除术是安全可行的，但术者必须具备丰富的全胸腔镜下操作经验和娴熟的技巧。
目的：通過對102例實施肺段切除術患者的臨床迴顧性分析，探討全胸腔鏡下肺段切除術的安全性和可行性。方法迴顧性的分析瞭1997年10月-2012年7月，上海市肺科醫院胸外科共實施全胸腔鏡下肺段切除手術102例。其中全胸腔鏡左肺上葉舌段20例（19.61%）、左肺上葉後段4例（3.92%）、左肺上葉尖後段5例（4.90%）、左肺上葉尖前後段5例（4.90%）、左肺上葉尖段1例（0.98%）、左肺上葉尖前段1例（0.98%）、左肺上葉前段3例（2.94%）、左肺上葉前後段1例（0.98%）、左肺上葉舌段+左肺下葉10例（9.80%）、左肺上葉後段+右肺下葉1例（0.98%）、左肺下葉前內基底段2例（1.96%）、左肺下葉揹段6例（5.88%）、左肺下葉前基底段1例（0.98%）、右肺上葉後段14例（13.73%）、右肺上葉尖段3例（2.94%）、右肺上葉尖後段5例（4.90%）、右肺上葉尖前段1例(0.98%)、右肺上前段3例（2.94%）、右肺上葉後段+右肺下葉2例（1.96%）、右肺下葉揹段10例（9.80%）、右肺下葉揹段+中葉2例（1.96%）、右肺下葉揹段+前基底段1例（0.98%）、右上後段+右下揹段+左下揹段+左肺下葉基底段1例（0.98%）。結果本組患者肺功能MVV為51.0～146.1 L/min，平均(93.8±20.9)L/min，中位數93.4 L/min；佔64.0%～125.4%，平均(94.3±15.4)%，中位數96.0%。FEV 1為1.27～3.97 L，平均(2.68±0.7)L，中位數2.64 L；佔52.0%～117.9%，平均(88.2±16.4)%，中位數85.6%。本組無手術死亡，無術後早期死亡(30 d內)。本組手術時間90～330 min，平均(168±55.1)min，中位數150 min；術中齣血50～1800 mL，平均(275±402.8)mL，中位數150 mL；術中使用閉閤釘數2～12枚，平均(5.5±2.0)枚，中位數5枚；佔位大小0.3～7.5 cm，平均(2.6±1.6)cm，中位數2.5 cm。本組術後引流量100～900 mL，平均（300.87±91.95）mL，中位數275 mL；術後引流管置管時間2～12 d，平均（4.83±1.42）d，中位數4 d；術後住院天數3～15 d，平均（6.60±1.76）d，中位數6 d。1例中轉小切口開胸，開胸原因均為胸內廣汎粘連。本組1例患者術後併髮乳糜胸，經治療好轉齣院。本組術後病理診斷AHH 1例、肺泡上皮不典型腺瘤樣增生3例、錯構瘤4例、結締組織增生1例、大細胞癌2例、結覈肉芽腫8例、肺結覈8例、肺囊腫3例、肺泡細胞癌9例、機化性肺炎3例、轉移性腺癌3例、乳腺癌肺轉移1例、鱗癌10例、腺癌22例、腺鱗癌1例、炎性實變4例、硬化性血管瘤3例、神經內分泌癌1例、肺膿腫1例、真菌性肉芽腫3例、支氣管擴張10。結論全胸腔鏡下實施肺段切除術是安全可行的，但術者必鬚具備豐富的全胸腔鏡下操作經驗和嫻熟的技巧。
목적：통과대102례실시폐단절제술환자적림상회고성분석，탐토전흉강경하폐단절제술적안전성화가행성。방법회고성적분석료1997년10월-2012년7월，상해시폐과의원흉외과공실시전흉강경하폐단절제수술102례。기중전흉강경좌폐상협설단20례（19.61%）、좌폐상협후단4례（3.92%）、좌폐상협첨후단5례（4.90%）、좌폐상협첨전후단5례（4.90%）、좌폐상협첨단1례（0.98%）、좌폐상협첨전단1례（0.98%）、좌폐상협전단3례（2.94%）、좌폐상협전후단1례（0.98%）、좌폐상협설단+좌폐하협10례（9.80%）、좌폐상협후단+우폐하협1례（0.98%）、좌폐하협전내기저단2례（1.96%）、좌폐하협배단6례（5.88%）、좌폐하협전기저단1례（0.98%）、우폐상협후단14례（13.73%）、우폐상협첨단3례（2.94%）、우폐상협첨후단5례（4.90%）、우폐상협첨전단1례(0.98%)、우폐상전단3례（2.94%）、우폐상협후단+우폐하협2례（1.96%）、우폐하협배단10례（9.80%）、우폐하협배단+중협2례（1.96%）、우폐하협배단+전기저단1례（0.98%）、우상후단+우하배단+좌하배단+좌폐하협기저단1례（0.98%）。결과본조환자폐공능MVV위51.0～146.1 L/min，평균(93.8±20.9)L/min，중위수93.4 L/min；점64.0%～125.4%，평균(94.3±15.4)%，중위수96.0%。FEV 1위1.27～3.97 L，평균(2.68±0.7)L，중위수2.64 L；점52.0%～117.9%，평균(88.2±16.4)%，중위수85.6%。본조무수술사망，무술후조기사망(30 d내)。본조수술시간90～330 min，평균(168±55.1)min，중위수150 min；술중출혈50～1800 mL，평균(275±402.8)mL，중위수150 mL；술중사용폐합정수2～12매，평균(5.5±2.0)매，중위수5매；점위대소0.3～7.5 cm，평균(2.6±1.6)cm，중위수2.5 cm。본조술후인류량100～900 mL，평균（300.87±91.95）mL，중위수275 mL；술후인류관치관시간2～12 d，평균（4.83±1.42）d，중위수4 d；술후주원천수3～15 d，평균（6.60±1.76）d，중위수6 d。1례중전소절구개흉，개흉원인균위흉내엄범점련。본조1례환자술후병발유미흉，경치료호전출원。본조술후병리진단AHH 1례、폐포상피불전형선류양증생3례、착구류4례、결체조직증생1례、대세포암2례、결핵육아종8례、폐결핵8례、폐낭종3례、폐포세포암9례、궤화성폐염3례、전이성선암3례、유선암폐전이1례、린암10례、선암22례、선린암1례、염성실변4례、경화성혈관류3례、신경내분비암1례、폐농종1례、진균성육아종3례、지기관확장10。결론전흉강경하실시폐단절제술시안전가행적，단술자필수구비봉부적전흉강경하조작경험화한숙적기교。
Objective Through the clinical retrospective analysis of 102 patients who had undergone pulmonary segment resection, the security and feasibility of pulmonary segment resection by VATS were discussed. Methods Were retrospectively analyzed from October 1997 to July 2012, Shanghai pulmonary hospital thoracic surgery were performed under the thoracoscope lung resection surgery in 102 cases. Surgical procedure:the left lung ligule period of 20 cases (19.61%), upper lobe left lung after period of 4 cases (3.92%), on the left lung tip posterior segment in 5 patients (4.90%), left lung tip on before and after the period of 5 cases (4.90%), left lung tip section in 1 case (0.98%), on the left lung tip forepart 1 cases (0.98%), left lung on leaf forepart in 3 patients (2.94%), upper lobe left lung before and after the period of 1 cases (0.98%), left lung on leaf tongue section+left lung lower lobe 10 cases (9.80%), left lung on leaf posterior segment+right lower lobe 1 cases (0.98%), left lung before lower lobe in basement section 2 cases (1.96%), left pulmonary lower lobe back period of 6 patients (5.88%), left pulmonary lower lobe former basal segment 1 cases (0.98%), the upper lobe posterior segment of 14 cases (13.73%), the upper tip section 3 cases (2.94%), the upper tip posterior segment in 5 patients (4.90%), the upper tip forepart 1 cases (0.98%), the upper forepart in 3 patients (2.94%), the upper lobe posterior segment+right lower lobe 2 cases (1.96%), the right lower lobe back period of 10 cases (9.80%), the right lower lobe back period of middle+2 cases (1.96%), the right lower lobe back period before+basal segment 1 cases (0.98%), upper right posterior segment+lower right back period of+left lower back period of+left lung lower lobe basal segment 1 cases (0.98%). Results The pulmonary function of patients with MVV was 51.0-146.1 L/min, an average of (93.8±20.9) L/min, median 93.4 L/min;64.0%-125.4%, average (894.3±15.4)%, median 96.0%. The FEV 1 1.27 L-3.97 L, average (2.68 L±0.7) L, median 2.64 L;52.0%-117.9%, average (88.2 ±16.4)%, median 85.6%.There were no operation death, no early postoperative death (within 30 days). The operation time of 90 min to 330 min, average (168 ±55.1) min;median 150 min,intraoperative bleeding in 50 mL-1800 mL, average (275±402.8)mL , median 150 mL;intraoperative use of closed nailing numbers 2 to 12, with an average of (5.5±2.0),median 5;occupied size 0.3 cm-7.5 cm, an average of 2.6 cm ± 1.6 cm, with a median of 2.5 cm. Postoperative drainage volume of 100-900 mL, average ( 300.87±91.95) mL, median 275 mL.Extubation time was 2 days to 12 days, the average ( 4.83±1.42) days, median 4 days;postoperative hospital stay of 3 days to 15 days, the average ( 6.60 ± 1.76) days, median 6 days.In 1 cases of small incision thoracotomy in transit, the reason is chest widely in the adhesion. Chylothorax occurred in 1 patient, recovered after treatment.The postoperative pathological diagnosis AHH 1 case, alveolar epithelium atypical adenomatoid hyperplasia 3 patients, hamartoma 4 cases, connective tissue hyperplasia in 1, large cell carcinoma, 2 cases, tuberculosis granuloma 8 cases, pulmonary tuberculosis 8 cases, pulmonary cyst (3 cases), alveolar cell carcinoma 9 cases, organization pneumonia in 3 patients, metastatic adenocarcinoma 3 cases, pulmonary metastasis of breast cancer in 1, 10 cases of squamous cell carcinoma, adenocarcinoma (22 cases), gland squamous carcinoma in 1, inflammatory real variable 4 cases, sclerosing hemangioma (3 cases), neuroendocrine carcinoma 1 cases, pulmonary abscess 1 cases, fungal granuloma in 3 patients, 10 cases of bronchiectasis.Conclusion Pulmonary segment resection under thoracoscopy is a safe and feasible method, but the operator must have rich operating experience and consummate skill.
