Endo Shunsuke, Tsubochi H, Matsuzawa S, Hori D, Nakano T, Sohara Y
Department of General Thoracic Surgery, Saitama Medical Center, Jichi Medical School, Saitama, Japan.
Kyobu Geka. 2008 May;61(5):375-8.
Patients with advanced non-small cell lung cancer invading a chest wall are surgical candidates if complete resection is possible. When a primary tumor locating the lower lobe invades an inferior chest wall, either a wide skin incision or double skin incisions to secure surgical views both for dissection of hilum and mediastinum and for inferior chest wall resection is necessary. Wider incision causes higher rate of wound necrosis and infection. We describe a combined approach of thoracoscopic and open chest surgery for lobectomy and inferior chest wall resection, respectively. Patient was a 68-year-old man with an advanced non-small cell lung cancer. Video-assisted thoracoscopic middle and lower lobectomies and mediastinal nodal dissection was completed via 5 ports. Chest wall resection including the posterior portion of the 9th and 10th ribs and the transverse process followed inferior postero-lateral thoracotomy. Postoperative course was uneventful. The present surgical approach can avoid a wide thoracotomy for an advanced lung cancer invading an inferior chest wall.
如果能够完整切除，晚期非小细胞肺癌侵犯胸壁的患者是手术候选者。当位于下叶的原发性肿瘤侵犯下胸壁时，为了确保在进行肺门和纵隔解剖以及下胸壁切除时都有手术视野，需要做一个宽的皮肤切口或两个皮肤切口。更宽的切口会导致更高的伤口坏死和感染率。我们描述了一种分别通过胸腔镜和开胸手术联合进行肺叶切除和下胸壁切除的方法。患者是一名68岁的晚期非小细胞肺癌男性。通过5个切口完成了电视辅助胸腔镜下中、下肺叶切除及纵隔淋巴结清扫。在进行后外侧下胸廓切开术后，进行了包括第9和第10肋骨后部及横突的胸壁切除。术后过程顺利。目前的手术方法可以避免对侵犯下胸壁的晚期肺癌进行广泛的胸廓切开术。
