摘要
目的总结全胸腔镜下肺叶切除手术的病例资料，分析由于淋巴结的干扰导致中转开胸的原因和应对措施。方法2006年9月至2013年4月接受全胸腔镜肺叶切除手术1006例中男545例，女461例；年龄13—86岁，中位60岁。手术方式包括肺段切除13例，单纯肺叶切除846例，复合肺叶切除131例，全肺切除8例，袖式切除8例。术后病理包括恶性疾病821例，良性疾病185例。手术操作为全胸腔镜下解剖性肺叶切除术。全组中转开胸手术83例，主动中转70例，被动中转13例。其中59例是由于“门钉”淋巴结的干扰导致中转开胸。结果术后患者均恢复良好。中转开胸组与全镜下完成手术组比较，手术时间明显延长[（272．7±67．2）min对（186．9±58．1）min，P=0．001]，术中出血明显增加[（564．2±507．7）ml对（158．0±121．0）ml，P=0．001]，术后带管天数明显延长[（8．9±5．0）天对（6．6±3．5）天，P=0．001]，术后住院天数明显延长[（12．5±7．7）天对（9．2±5．8）天，P=0．001]。结论淋巴结的干扰是全胸腔镜肺叶切除手术中转开胸最主要的原因，导致手术时间延长，术中出血增加，术后恢复延迟。灵活把握中转的指征和时机，及时作出预判，可以减轻中转开胸带来的负面影响。
Objective Summarize all cases received completely thoracoscopic lobectomy, analyze the influence of lymph nodes in conversion thoracotomy and its measurements. Methods Between September 2006 to April 2013, 1006 patients （545 males, 461 females, median age 60 years, ranged from 13 to 86 years） received completly thoraeoscopic lobectomy, in- cluding segmectomy （ n = 13 ） , simple lobeetomy （ n = 846 ） , compound lobectomy （ n = 13 1 ） , prmumoneetomy （ n = 8 ） , sleeve lobectomy（n =8）. The main procedure was completely video-assisted anatomical lobectomy with mediastinal lymphadenectomy as we have reported. Results The average operative time in the conversion thoracotomy group was significantly longer[ （272. 7 ± 67.2 ） min versus （ 186.9 ± 58.1 ） min, P = 0. 001 ] compared with completely endoscopic surgery group, the average blood loss was significantly increased[ （564.2 ± 507.7 ） ml versus（ 158.0 ± 121.0） ml, P = 0. 001 ] , the drainage time was significantly longer[ （8.9 ± 5. 0）days versus （6.6 ± 3.5 ） days, P = 0. 001 ] and the postoperative hospital stay was significantly longer [ （ 12.5 ± 7.7 ） days versus （ 9.2 _± 5.8 ） days, P = 0. 001 ]. Conclusion Interference of lymph doeds was the main reason for conversion to thoracotomy on VATs lobectomy. It may prolonged the operative time, increase the blood loss in operation and de- lay the postoperative recovery of the patients. Select the proper indication of conversion thoracotomy may reduce the negative effects of conversion thoracotomy.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2013年第10期591-594,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
卫生部部属（管）医院临床学科重点项目（全胸腔镜肺叶切除治疗早期非小细胞肺癌技术优化与应用推广）
首都医学发展科研基金（2009-1017）
首都临床特色应用研究（D101100050010027）
关键词
胸腔镜检查
肺切除术
淋巴结
中转开胸
Thoracoscopy
Pneumonectomy
lymph nodes
Conversion thoracotomy
