Okada Morihito
Department of Thoracic Surgery, Hyogo Medical Center for Adults, Akashi, Japan.
Kyobu Geka. 2006 Jul;59(8 Suppl):724-9.
Of late, small-sized lung cancers have become much more often found with the development of diagnostic image techniques. This article reviews the current status of radical sublobar resection such as segmentectomy and wide wedge resection for a peripheral clinical NO lung cancer tumor 2 cm or less in diameter in patients able to tolerate a lobectomy, with emphasis on its invasiveness as well as techniques and results. Several recent reports suggest that clinical results of sublobar resection in such highly selected patients is not worse than those of standard lobectomy. In addition to preservation of pulmonary function, this lung-saving surgery must provide a second chance to patients who have a higher risk of metachronous disease after surviving a first disease. Also, with the great interest in minimally invasive techniques for treating various pathologies, we have widely applied an integrated surgical approach that combines muscle-sparing minithoracotomy (incision, 4-8 cm) and video-assistance using mainly direct visualization of the lung resection, which we have called hybrid video-assisted thoracic surgery (VATS). The combination of sublobar resection and hybrid VATS might be an alternative as a much less invasive standard operation for patients with small peripheral lung cancers.
近年来，随着诊断影像技术的发展，小尺寸肺癌的发现频率大幅增加。本文回顾了对于能够耐受肺叶切除术的患者，直径2厘米及以下的外周临床NO期肺癌肿瘤行肺段切除术和广泛楔形切除术等根治性亚肺叶切除术的现状，重点关注其侵袭性以及技术和结果。最近的几份报告表明，在这类经过严格筛选的患者中，亚肺叶切除术的临床效果并不比标准肺叶切除术差。除了保留肺功能外，这种保肺手术还必须为在首次疾病中存活后发生异时性疾病风险较高的患者提供第二次机会。此外，鉴于对治疗各种病症的微创技术的高度关注，我们广泛应用了一种综合手术方法，该方法结合了保留肌肉的小切口开胸术（切口4 - 8厘米）和主要通过直接观察肺切除进行的视频辅助，我们将其称为混合视频辅助胸腔镜手术（VATS）。亚肺叶切除术与混合VATS相结合，可能成为小外周肺癌患者侵入性小得多的标准手术替代方案。
