Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, USA.
Semin Thorac Cardiovasc Surg. 2010 Autumn;22(3):244-9. doi: 10.1053/j.semtcvs.2010.10.014.
Experience reported in the literature increasingly supports the notion that segmentectomy is comparable with lobectomy for small tumors (≤2 cm), provided that the lesion is located centrally and affords a 2-cm parenchymal surgical margin. In a recent retrospective study that compared video-assisted thoracic surgery (VATS) lobectomy to VATS segmentectomy, the authors concluded that segmentectomy yields excellent oncological results with comparable morbidity, mortality, locoregional recurrence, and 3-year survival. Moreover, patients in both surgical groups were discharged after similar length hospital stays although patients undergoing VATS segmentectomy had worse pulmonary function before surgery. Perceived difficulties with new applications of minimally invasive surgeries disappear as experience increases, permitting application to technically more challenging operations. A technical description of VATS segmentectomy is provided, including 2 new methods for ensuring the exact delineation of the fissure.
文献中越来越多的经验报告支持这样一种观点，即对于≤2cm 的小肿瘤，段切除术与肺叶切除术相当，前提是病变位于中央且能提供 2cm 的实质手术切缘。在一项最近比较电视辅助胸腔镜手术（VATS）肺叶切除术和 VATS 肺段切除术的回顾性研究中，作者得出结论，肺段切除术可获得与肺叶切除术相似的肿瘤学结果，且具有相当的发病率、死亡率、局部区域复发率和 3 年生存率。此外，两组手术患者的住院时间相似，但接受 VATS 肺段切除术的患者在手术前的肺功能较差。随着经验的增加，微创外科新技术的应用难度降低，从而可以应用于技术上更具挑战性的手术。本文提供了 VATS 肺段切除术的技术描述，包括 2 种新方法，可确保精确划定肺裂。
