Liu Lun-Xu, Liu Cheng-Wu, Yang Jun-Jie
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2013 Jan;44(1):104-8.
Video-assisted thoracoscopic surgery (VATS) lobectomy is a less invasive procedure when compared with the traditional thoracotomy. With the development of operative techniques, VATS lobectomy has become a definite procedure for stage I and some stage II a lung cancer. However, it is still controversial due to operative difficulty whether it is feasible to perform thoracoscopic surgery in anatomic pulmonary segmentectomy, bronchial sleeve lobectomy, bronchial and arterial sleeve lobectomy, large tumor (> 5 cm), pneumonectomy and resection of Pancoast tumor. Some difficulties in performing thoracoscopic lobectomy such as: pleural cavity adhesions or atresia, local invasion, interlobar fissure dysplasia, bleeding, as well as "troublesome hilum", were once thought to be indication for conversion to thoracotomy. We proposed a new concept of thoracoscopic lung resection: "single-direction thoracoscopic lobectomy", which has been proved to be simple, safe, and effective and has been widely accepted in our country. In practice, we are still proceeding with further exploration, technical optimization and expanding its application in more complicated lung surgery. For instance, we have developed strategies of "fast recovery" and "mini-invasive diagnosis and synchronous treatment of lung cancer" and a series of stylized techniques such as thoracoscopic adhesiolysis, bloodless technique, suction-compressing angiorrhaphy technique, presumptive control of the main pulmonary artery, hollow-out method in thoracoscopic lobectomy. With accumulative experience utilizing these innovative techniques, we believe that thoracoscopic lobectomy would become the mainstream for surgical management of pulmonary diseases.
与传统开胸手术相比，电视辅助胸腔镜手术（VATS）肺叶切除术是一种侵入性较小的手术。随着手术技术的发展，VATS肺叶切除术已成为I期和部分IIa期肺癌的确定性手术。然而，由于手术难度，在解剖性肺段切除术、支气管袖状肺叶切除术、支气管和动脉袖状肺叶切除术、大肿瘤（>5cm）、全肺切除术以及潘科斯特瘤切除术等手术中，胸腔镜手术是否可行仍存在争议。一些胸腔镜肺叶切除术的困难，如胸腔粘连或闭锁、局部侵犯、叶间裂发育异常、出血以及“棘手的肺门”，曾被认为是转为开胸手术的指征。我们提出了一种新的胸腔镜肺切除概念：“单向胸腔镜肺叶切除术”，已被证明简单、安全且有效，并在我国得到广泛认可。在实践中，我们仍在继续进一步探索、技术优化，并将其应用扩展到更复杂的肺部手术中。例如，我们已经制定了“快速康复”和“肺癌微创诊断与同步治疗”策略，以及一系列程式化技术，如胸腔镜粘连松解术、无血技术、吸引压迫血管缝合技术、主肺动脉的推定控制、胸腔镜肺叶切除术中的掏空法。随着利用这些创新技术积累的经验，我们相信胸腔镜肺叶切除术将成为肺部疾病外科治疗的主流。
