Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado 80045, USA.
Ann Thorac Surg. 2012 Apr;93(4):1033-9; discussion 1039-40. doi: 10.1016/j.athoracsur.2012.01.012. Epub 2012 Mar 3.
The potential benefits of thoracoscopic lobectomy and segmentectomy for early stage non-small cell lung cancer have been well documented in the literature. However, little is known about the use of these techniques in patients requiring resection for infectious or inflammatory lung disease.
Using a prospectively collected database, we performed a retrospective review of consecutive operations from July 2004 to June 2010. All patients who underwent elective thoracoscopic lobectomy or segmentectomy for focal bronchiectasis or cavitary lung disease associated with active pulmonary infection were included.
In all, 212 resections were performed in 171 patients. The average age was 59 years (range, 26 to 82 years). Patients were predominately white (93%) and female (93%). Indications for surgery included recurrent active infection, hemoptysis, or antibiotic intolerance associated with focal bronchiectasis (86%), cavitary disease (7%), or both (7%). Operations included 126 lobectomies, 73 segmentectomies, 10 lobe plus segmental resections, and 3 bilobectomies. Conversion to thoracotomy occurred in 10 patients. The operative mortality rate was zero. Complications occurred in 9%, consisting largely of prolonged air leak and atrial fibrillation. The mean hospital length of stay was 3.7 days.
Thoracoscopic lobectomy and segmentectomy for individuals with infectious lung disease can be accomplished safely with minimal morbidity and mortality. These techniques may provide the optimal surgical approach for patients with focal bronchiectasis or cavitary lung disease requiring resection.
胸腔镜肺叶切除术和肺段切除术在早期非小细胞肺癌中的潜在益处已在文献中得到充分证明。然而，对于需要切除感染或炎症性肺部疾病的患者，这些技术的应用知之甚少。
我们使用一个前瞻性收集的数据库，对 2004 年 7 月至 2010 年 6 月期间连续进行的手术进行了回顾性分析。所有接受胸腔镜肺叶切除术或肺段切除术治疗局灶性支气管扩张或与活动性肺部感染相关的空洞性肺部疾病的患者均纳入研究。
共对 171 例患者的 212 例手术进行了研究。平均年龄为 59 岁（范围 26 岁至 82 岁）。患者主要为白人（93%）和女性（93%）。手术指征包括复发性活动性感染、咯血或与局灶性支气管扩张（86%）、空洞性疾病（7%）或两者均有关的抗生素不耐受。手术包括 126 例肺叶切除术、73 例肺段切除术、10 例肺叶加肺段切除术和 3 例双肺叶切除术。10 例患者中转开胸。手术死亡率为零。并发症发生率为 9%，主要为长时间漏气和心房颤动。平均住院时间为 3.7 天。
对于患有肺部感染性疾病的个体，胸腔镜肺叶切除术和肺段切除术可以安全进行，发病率和死亡率均较低。对于需要切除的局灶性支气管扩张或空洞性肺部疾病患者，这些技术可能提供了最佳的手术方法。
