【摘要】 目的:探讨近距离两孔法胸腔镜肺叶切除加系统性淋巴结清扫术的安全性、可行性及优缺点。方法:2012年9月至2014年9月为113例肺癌患者行近距离两孔胸腔镜下肺叶切除加纵隔淋巴结清扫术。操作孔位于腋前线第4肋间,长2~4 cm;观察孔位于操作孔下一肋间腋前线,长约1.5 cm。收集围手术期指标,包括手术时间、术中失血量、术后引流量及拔除胸腔闭式引流管时间、术中清扫淋巴结数量、术后并发症、住院时间、住院费用。结果:术后均无死亡病例,发生并发症12例,其中4例漏气超过7 d,保守治疗后均于2周内停止漏气;肺炎2例,加强咳嗽咳痰,更换抗生素后肺炎消失;肺不张2例,持续负压吸引,加强呼吸锻炼、咳嗽咳痰,均于一周内复张;切口感染1例,经过换药治疗愈合;术后阵发性房颤3例,经保守治疗后转律。结论:近距离两孔法胸腔镜肺叶切除及系统性纵隔淋巴结清扫术是安全、可行的,术后疼痛轻,是可选择的安全、有效的肺癌根治性手术方式之一。更多还原

【Abstract】 Objective:A new operation method is introduced:close distance two-port thoracoscopic lobectomy and systematic dissection of the mediastinal nodes.The safety,feasibility,advantages and disadvantages of this method is evaluated.Methods:Between Sep.2012 and Sep.2014,113 lung cancer patients were performed close distant two-port thoracoscopic lobectomy and systematic mediastinal lymph node dissection.The operating port( length 2-4 cm) was located at the fourth intercostal space crossing the anterior axillary line.The observing port( length 1.5 cm) was at the next intercostals inferior to the operating port.The data,including operative duration,intraoperative blood loss,duration and volume of chest tube drainage,number of lymph nodes dissected,postoperative complications,hospital stay after surgery,hospitalization expenses,were analyzed.Results:No death occurred in the perioperative period.12 complications occurred.4 cases of persistent air leakage for more than 7 d,stopped leaking by conservative treatment in two weeks.Two pneumonia cases recovered by enhanced expectoration and change of the antibiotics.2 cases of atelectasis recruited in one week by breath training,coughing,and continuous negative pressure suction.Incision infection healed up after dressing change.3 cases of paroxysmal atrial fibrillation got cardioversion by conservative treatment.Conclusions:The method of close distance two ports thoracoscopic lobectomy and systematic dissection of the mediastinal nodes is safe,practicable and effective.Postoperative pain can be reduced with this operative method.It can be one of the routine surgeries for lung cancer.更多还原