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目的在过去10~15年里,香港、日本和西方的临床医生开展了非小细胞肺癌的电视胸腔镜肺叶切除手术。虽然此种技术的支持者发表了结果满意的文章,但毫无疑问有些病人遭受了由于医生的技术尚处于学习曲线阶段或由于病例选择不当造成的失误。杂志投稿零星的报道和在国际会议上的个人交流并未被广泛传播,而且外科医生不太可能发表效果不好的结果,这些都导致报道的阳性误差。尽管我们中心已经有650例胸腔镜手术的经验,其中还包括食管切除、扩大胸腺切除、膈肌修补等复杂手术,但我们对开展非小细胞肺癌胸腔镜肺叶切除术仍很谨慎,因为我们不希望危及开胸手术的良好效果。另外,为了向中国医生全面系统地介绍这一经过慎重考虑的技术,对于将要开展胸腔镜肺叶切除术的医院,我们推荐了一个10步方案。本文还将介绍我们中心开展胸腔镜肺叶切除的经历,在过去12个月中技术的提高呈指数级增长,学习曲线达到平台期。本文详细介绍电视胸腔镜肺叶切除术,40例手术无死亡,5年生存率86%。根据现有的证据,在中国目前正在继续进行医疗改革之际,对合适的非小细胞肺癌进行胸腔镜手术应会使广大的人群获益。
Objectives In the past 10 to 15 years, clinicians in Hong Kong, Japan and the West conducted video-assisted thoracoscopic lobectomy for non-small cell lung cancer. Although the proponents of such technologies have published satisfactory results, there is no doubt that some patients have suffered mistakes due to the doctor’s skills being in the learning curve or due to improper patient selection. Sporadic coverage of magazine articles and personal communication at international conferences have not been widely disseminated, and it is unlikely that surgeons will report poor results, all of which lead to positive reporting errors. Although our center already has 650 cases of thoracoscopic surgery, including esophagectomy, enlarged thymus resection and diaphragmatic repair, we are still cautious about thoracoscopic lobectomy for non-small cell lung cancer because we do not want Endanger the good effect of thoracotomy. In addition, to introduce this carefully considered technique to Chinese doctors in a comprehensive and systematic manner, we recommend a 10-step protocol for a hospital where thoracoscopic lobectomy will be performed. This article will also describe our experience with thoracoscopic lobectomy in our center, with an exponential increase in technology over the past 12 months and a learning curve reaching the plateau. This article details the video thoracoscopic lobectomy, 40 cases of surgery without death, 5-year survival rate of 86%. Based on the available evidence, thoracoscopic surgery for the right non-small cell lung cancer should benefit the general population as China continues its healthcare reform.