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|本期目录/Table of Contents|

 全胸腔镜肺叶切除术中转开胸手术指征的探讨()

《中国胸心血管外科临床杂志》[ISSN:1007-4848/CN:51-1492/R]

期数:
2010年第17卷第1期
页码:
32-35
栏目:
临床研究论著
出版日期:
2010-02-25

文章信息/Info

Title:
 Indications for Conversion to Thoracotomy in Completely Thoracoscopic Lobectomy
文章编号:
1007-4848（2010）01-0032-04
作者:
 李运 杨帆 刘彦国 等
 北京大学人民医院 胸外科， 北京 100044
Author(s):
 LI Yun;  YANG Fan;  LIU Yan-guo;  et al .
 Department of Thoracic Surgery, People’s Hospital, Peking University, Beijing, 100044, P.R.China
关键词:
 ; 全胸腔镜;  肺叶切除术;  中转开胸;  手术指征
Keywords:
 ; Completely thoracoscopic;  Lobectomy;  Conversion to thoracotomy;  Indication
分类号:
R665.3; R734.2;
DOI:
-
文献标识码:
A
摘要:
 目的 为了更好地把握全胸腔镜肺叶切除术中转开胸的时机，探讨全胸腔镜肺叶切除中各种原因中转开胸的手术指征。 方法 2006年9月至2009年2月共施行全胸腔镜肺叶切除术172例，男88例，女84例；平均年龄58.9岁。术后病理：原发性肺癌133例，肺转移癌或其他恶性肿瘤7例，良性疾病32例。病变位于右肺上叶46例，右肺中叶23例，右肺下叶31例，左肺上叶36例，左肺下叶36例。手术均通过3个切口完成，肺叶解剖性切除和系统性淋巴结清扫的操作顺序与常规开胸手术基本相同。如镜下操作遇纵隔淋巴结粘连或转移、出血等特殊情况，则延长操作口至12~15 cm，转为开胸手术。按肿瘤最大径分为最大径≥5 cm组和最大径≤3 cm组；再按是否中转开胸将患者分为中转开胸组和未开胸组，分别比较两组患者的临床资料。 结果 全部患者手术顺利，无严重并发症及围手术期死亡发生。全组手术时间185 min，术中出血213 ml。中转开胸13例，中转开胸率7.6%。其中淋巴结干扰9例，出血4例。开胸后完成肺叶切除12例，全肺切除1例。其中肿瘤最大径≥5 cm组16例，手术时间187 min，出血203.8 ml；最大径≤3 cm组98例，手术时间202 min，出血231.3 ml，两组数据比较差异无统计学意义。中转开胸组13例，平均年龄68.7岁，实体瘤最大径23.8 mm；未开胸组159例，平均59.3岁，实体瘤最大径27.8 mm，两组年龄差异有统计学意义（P=0.016），而实体瘤最大径差异无统计学意义（P=0.404）。 结论 淋巴结干扰和出血是主要的中转开胸的原因，肿瘤大小、叶间裂分化情况及胸腔粘连不是常见的中转开胸的原因。
Abstract:
 Objective To find out the best time and investigate the indications for conversion to horacotomy in completely thoracoscopic lobectomy. Methods Between Sep. 2006 and Feb. 2009, 172 patients including 88 male and 84 female with the median age of 58.9 years, underwent completely thoracoscopic lobectomy. Postoperative pathology showed that there were 133 cases of primary lung cancer, 7 cases of lung cancer metastasis and other malignant tumors, and 32 cases of benign diseases. Among them, 46 patients had the tumor on the right upper lobe (RUL), 23 on the right middle lobe (RML), 31 on the right lower lobe (RLL), 36 on the left upper lobe (LUL) and 36 on the left lower lobe (LLL). Three incisions were made in all operations. The procedures of systematic lymphadenectomy and anatomic lobectomy were similar with routine thoracotomy. If there was mediastinal lymph node adhesion, metastasis or bleeding, the incision would be extended to 12-15 cm and the surgery would be converted to thoracotomy. According to whether the maximum tumor dimension was above 5 cm or under 3 cm, the patients were divided into two groups. At the same time, we also divided the patients into two groups based on whether thoracotomy was performed. The data of both two groups were compared respectively. Results All surgeries were carried out safely with no serious complications or perioperative deaths. The average surgical duration was 185 minutes, and the average blood loss was 213 ml. Thirteen operations were converted to thoracotomy with a conversion rate of 7.6%. Among them, 9 were interfered by lymph nodes and bleeding happened in 4 operations. Lobectomy was performed on 12 patients and pneumonectomy was performed on 1 patient after thoracotomy. For the 16 cases of tumor with its dimension larger than 5 cm, the average operation time was 187 minutes and the average blood loss was 203.8 ml, while for the 98 cases of tumor with its dimension smaller than 3 cm, the average operation time was 202 minutes and the average blood loss was 231.3 ml. The difference between these two groups was not statistically significant. Among the 13 cases of conversion to thoracotomy, the mean age of the patients was 68.7 years old and the average tumor dimension was 23.8 mm. For the 159 cases without thoracotomy, the average age was 59.3 years old and the tumor dimension averaged 27.8 mm. There was a significant difference between them (P=0.016). Conclusion Interference by lymph nodes and bleeding are the most important causes of conversion to thoracotomy in completely thoracoscopic lobectomy while size of tumor, fused fissure or plural adhesions can be always managed thoracoscopically.

参考文献/References

备注/Memo

备注/Memo:
更新日期/Last Update: 2010-03-04