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目的探讨胸腔镜辅助小切口和常规后外侧切口在肺血管-支气管成形术治疗中央型肺癌中的可行性及效果。方法对广州医学院第一附属医院1995年1月至2007年7月139例采用胸腔镜辅助小切口术式及四川大学华西医院2000年4月至2005年12月99例采用常规后外侧切口术式的因病变涉及肺叶开口或肺动脉,而行肺血管-支气管成形术患者的临床资料进行回顾性分析。结果两组患者均顺利完成手术,无围手术期死亡,术后无吻合口狭窄、吻合口瘘及切缘癌细胞残留。胸腔镜辅助小切口组平均生存时间为63.17个月,常规后外侧切口组为42.00个月,术后生存率无明显差异。肺动脉成形患者的保留肺叶无肺再灌注损伤或明显肺水肿征象。胸腔镜辅助小切口组辅助切口的平均长度为10 cm,常规后外侧切口组切口平均长度为30 cm。胸腔镜辅助小切口组手术时间、术后胸管留置时间及住院时间均短于常规后外侧切口组,术后患侧肩关节功能障碍发生率低。结论利用胸腔镜辅助小切口施行肺血管-支气管成形术,不仅具有与常规后外侧切口相同的适应证和术后生存率,而且在减小手术创伤,促进患者恢复方面具有优势。
Objective To investigate the feasibility and effect of thoracoscopic assisted mini-incision and conventional posterior lateral incision in the treatment of central lung cancer with pulmonary vascular-bronchoplasty. Methods The first Affiliated Hospital of Guangzhou Medical College from January 1995 to July 2007 139 cases of thoracoscopic assisted small incision and Sichuan University West China Hospital from April 2000 to December 2005 99 cases of conventional posterior lateral incision The type of lung lesions due to the opening or pulmonary artery, and pulmonary vascular - bronchial surgery in patients with clinical data were analyzed retrospectively. Results The two groups of patients were successfully completed surgery, no perioperative death, no anastomotic stenosis, anastomotic fistula and resection margin cancer cell residue. The average survival time of the thoracoscopic assisted small incision group was 63.17 months, while that of the conventional posterior incision group was 42.00 months. The postoperative survival rate was no significant difference. Pulmonary arterial remodeling in patients with preserved pulmonary lobular lung injury or pulmonary edema symptoms. The average length of the auxiliary incision in the thoracoscopic assisted small incision group was 10 cm and the average length of the incision in the conventional posterior incision group was 30 cm. Thoracoscopic assisted small incision group operation time, postoperative chest tube retention time and hospitalization time were shorter than conventional posterior lateral incision group, postoperative ipsilateral shoulder joint dysfunction was low. Conclusions Pulmonary vascular-bronchoplasty using thoracoscopic assisted mini-incision not only has the same indications and postoperative survival rate as conventional posterior lateral incisions, but also has advantages in reducing surgical trauma and promoting patient recovery.