[1]杨德松,周勇,梁剑平,等.全胸腔镜下支气管/肺动脉切除成形肺叶切除术治疗中央型肺癌[J].中国微创外科杂志,2017,17(10):887-896.
 Yang Desong,Zhou Yong,Liang Jianping,et al.Complete Video-assisted Thoracoscopic Surgery of Bronchial and/or Pulmonary Arterial Resection and Lobectomy for Central Type Lung Cancer[J].Chinese Journal of Minimally Invasive Surgery,2017,17(10):887-896.
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全胸腔镜下支气管/肺动脉切除成形肺叶切除术治疗中央型肺癌()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年10期
页码:
887-896
栏目:
临床研究
出版日期:
2017-10-20

文章信息/Info

Title:
Complete Video-assisted Thoracoscopic Surgery of Bronchial and/or Pulmonary Arterial Resection and Lobectomy for Central Type Lung Cancer
作者:
杨德松周勇梁剑平李旭吴智宁吴劼唐金明张百华邓海斌王文祥**
中南大学湘雅医学院附属肿瘤医院湖南省肿瘤医院胸外二科,长沙410013
Author(s):
Yang Desong Zhou Yong Liang Jianping et al.
Department of Thoracic Surgery Ⅱ, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Hunan Cancer Hospital, Changsha 410013, China
关键词:
胸腔镜中央型肺癌肺叶切除
Keywords:
ThoracoscopeCentral type lung cancerLobectomy
文献标志码:
A
摘要:
目的探讨全胸腔镜下支气管/肺动脉切除成形肺叶切除术的可行性及探索性适应证。方法2016 年4~6月对 11 例中央型肺癌行全胸腔镜下支气管/肺动脉切除成形肺叶切除及系统性淋巴结清扫术,其中 3 例行右肺上叶支气管袖式切除成形术,7例行右肺上叶支气管楔形切除成形术,1例行左肺上叶支气管楔形切除成形及左肺动脉干侧壁成形肺叶切除。均采用三孔法全胸腔镜下解剖性肺叶切除。支气管成形采用连续缝合法,经主操作孔吻合成形,肺动脉成形采用近远端阻断后,经主操作孔侧壁成形后加固。结果11例均顺利完成肺叶切除,其中10例支气管切除成形重建,1例同时行肺动脉干成形,均行系统性淋巴结清扫。右肺上叶支气管楔形切除成形手术时间(切皮至缝皮,下同)210~300 min(中位时间240 min),右肺上叶支气管袖式切除成形手术时间210~300 min(中位时间270 min),左肺上叶支气管楔形切除成形+肺动脉干侧壁切除成形手术时间260 min。支气管楔形切除吻合时间 11~30 min,中位时间15 min;支气管袖式切除吻合时间 25~74 min,中位时间30 min;肺动脉侧壁成形15 min。术后无吻合口漏、出血、肺不张、肺部感染、刺激性咳嗽、咯血等并发症,无围手术期死亡。术后平均住院5.1 d(4~7 d)。术后病理:鳞癌9 例,腺癌1例,神经内分泌癌1 例。11例随访2~4个月,未见肿瘤复发转移征象。结论全胸腔镜支气管/肺动脉成形肺叶切除术治疗中央型肺癌安全可行,其探索性适应证为叶、段支气管开口且无明显肺门淋巴结钙化的中央型肺癌。
Abstract:
ObjectiveTo reseach the feasibility and indications of complete video-assisted thoracoscopic surgery (VATS) for bronchial and/or pulmonary arterial resection and lobectomy.MethodsA total of 11 patients underwent complete VATS of bronchial and/or pulmonary arterial resection and lobectomy from April to June 2016, including 3 cases of thoracoscopic right upper sleeve lobectomy,7 cases of thoracoscopic right upper bronchial wedge resection and reconstruction, and 1 case of thoracoscopic left upper bronchial wedge resection combine with pulmonary arterial resection and lobectomy. The complete VATS was performed with "3 ports method". The bronchial reconstruction was performed with continuous sutures through the main operating port. The pulmonary arterial reconstruction was conducted with side wall through the main operating port after the blockage of both arterial ends.ResultsThe 11 cases were given complete lobectomy with lymph node dissection successfully, inclding 10 cases of bronchial resection and reconstruction and 1 case of bronchial combined with pulmonary arterial resection and reconstruction. The operating time for right upper bronchus wedge resection and reconstruction was 210-300 min (median, 240 min), the operating time for right upper sleeve lobectomy was 210-300 min (median, 270 min), and the operating time for left upper bronchus wedge resection and reconstruction with pulmonary arterial reconstruction was 260 min. The bronchus wedge resection and reconstruction time was 11-30 min (median, 15 min), the sleeve suturing time was 25-74 min (median, 30 min), and the pulmonary arterial reconstruction time was 15 min. There were no serious complications after surgery, such as anastomotic leakage, postoperative hemorrhage, atelectasis, pulmonary infection, irritable cough, or hemoptysis. No peri-operative death happened. The mean length of postoperative hospital stay was 5.1 d (4-7 d). Postoperative pathological outcomes showed 9 cases of squamous carcinoma, 1 case of adenocarcinoma, and 1 case of neuroendocrine carcinoma. Follow-ups for 2-4 months in the 11 cases found no recurrence or metastasis. ConclusionComplete VATS of bronchial and/or pulmonary arterial resection and lobectomy is a safe and feasible option for central type lung cancer. The indication is central type lung cancer occurring in root of segmental or lobar bronchus and not be associated with lymphnode calcification.

参考文献/References:

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备注/Memo

备注/Memo:
基金项目:湖南省肿瘤医院青年科研基金课题(项目编号:A2013-09)**通讯作者,E-mail:wangwenxiang@hnszlyy.com
更新日期/Last Update: 2018-01-11