【摘要】 目的探讨电视胸腔镜辅助小切口(video-assistedminithoracotomy,VAMT)治疗非小细胞肺癌的手术方式和适应证。方法应用VAMT行肺叶切除术+淋巴结清扫75例。作1cm胸腔镜切口及腋下8￣10cm切口操作,摒弃常规的血管吻合器等昂贵的一次性器械,采用常规开胸手术器械与内镜器械相结合的方式行直视+腔镜下行肺叶切除术+纵隔肺门淋巴结清扫,所有血管和支气管结扎均同常规开胸方式。与同期63例常规开胸肺叶根治术进行比较研究。结果VAMT组手术完成顺利,手术时间较常规开胸手术多大约23min,但术中出血很少,术后恢复快,住院时间缩短,术后并发症少,总体费用少。与常规开胸组相比,淋巴结的清扫数量及程度上均没有差异,对患者而言,性价比明显高于常规开胸手术。结论VAMT治疗非小细胞肺癌,既发挥了电视胸腔镜(videoassistedthoracoscopicsurgery,VATS)手术在微创方面的优势,避免了伴随而来的高昂费用,近期的治疗效果又不弱于传统开胸手术。但手术操作技术要求较常规开胸手术高,胸腔镜切口是手术得以完成的关键。更多还原

【Abstract】 [Objective] To evaluate the surgical technique and indication of Video-assisted minithoracotomy(VAMT) in patients with Non-small cell lung cancer(NSCLC). [Methods] From January 2004 to November 2005, 138 patients with NSCLC underwent lobectomy or lobectomy and lymph node dissections, 75 of which with VAMT. The minimal incision from 8 cm to 10 cm was made at fifth or sixth intercostal space. All surgery were finished with conventional thoracotomy instruments combined with non-disposable thoracoscopic instruments. The transfixion technique of all stumps of vessels and bronchus were identical to that of open thoracotomy. [Results] Surgery of both VAMT group and control group were completed satisfactorily. As to the extent of lymph node clearance, We observed no difference between their two groups. But VAMT brought us less intraoperative blood loss, quicker recovery, shorter length of postoperative hospital stay, less cost of hospitalization. [Conclusion] Application of VAMT in patients with NSCLC, which combined advantages of both VATS and conventional thoracotomy. The near future effect identical to thot of conventional thoracotomy. But VAMT required more sophisicated operative techniques, VATS incision is the key to the surgical completion.更多还原