Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
Semin Thorac Cardiovasc Surg. 2011 Spring;23(1):73-7. doi: 10.1053/j.semtcvs.2011.04.001.
We perform segmentectomy for patients with cT1N0 non-small cell lung cancer (NSCLC) of 2 cm or less, even in good-risk patients. Hilar dissection and intersegmental dissection are performed by using mainly direct visualization through the access thoracotomy, which is called hybrid video-assisted thoracic surgery (VATS). Identification of the intersegmental plane is performed by selective jet ventilation under bronchofiberscopy. With this method, the segment to be removed can be inflated, while the segments to be preserved are kept deflated. When the intersegmental plane is being divided by electrocautery, direct visualization during the hybrid VATS approach is extremely important, because a 3-dimensional understanding of the pulmonary anatomy is crucial to avoid ambiguous procedures.
我们为 2cm 或以下的 cT1N0 非小细胞肺癌（NSCLC）患者施行肺段切除术，即使是低危患者也如此。通过经胸廓入路主要采用直接可视化来进行肺门解剖和节段间解剖，这种方法被称为杂交电视辅助胸腔镜手术（VATS）。通过纤维支气管镜下选择性射流通气来识别节段间平面。使用这种方法，可以对要切除的段进行充气，同时保持要保留的段处于萎陷状态。当用电烙术分割节段间平面时，杂交 VATS 方法中的直接可视化极为重要，因为对肺解剖结构的三维理解对于避免模糊的手术过程至关重要。
