Xu Keping, Zhang Zhi, Zhao Jianqiang, Huang Jianfeng, Yin Rong, Xu Lin
Department of Thoracic Surgery, Nanjing Medical University, Nanjing, Jiangsu 210029, China; ; Department of Thoracic Surgery, Huai'an First Peoplex's Hospital, Huaian, Jiangsu 223300, China;
J Biomed Res. 2013 Jul;27(4):310-7. doi: 10.7555/JBR.27.20120066. Epub 2013 Mar 10.
Lobectomy with partial removal of the pulmonary artery in video-assisted thoracic surgery (VATS) currently remains a challenge for thoracic surgeons. We were interested in introducing pulmonary vessel blocking techniques in open thoracic surgery into video-assisted thoracic surgery (VATS) procedures. In this study, we reported a surgical technique simultaneously blocking the pulmonary artery and the pulmonary vein for partial removal of the pulmonary artery under VATS. Seven patients with non-small-cell lung cancer (NSCLC) received lobectomy with partial removal of the pulmonary artery using the technique between December 2007 and March 2012. Briefly, rather than using a small clamp on the distal pulmonary artery to the area of invading cancer, we replaced a vascular clamp with a ribbon and Hem-o-lock clip to block the preserved pulmonary veins so as to prevent back bleeding and yield a better view for surgeons. The mean occlusion time of the pulmonary artery and pulmonary veins were 44.0±10.0 and 41.3±9.7 minutes, respectively. The mean repair time of the pulmonary artery was 25.3±13.7 minutes. No complications occurred. No patients showed abnormal blood flow through the reconstructed vessel. There were no local recurrences on the pulmonary artery. In conclusion, the technique for blocking the pulmonary artery and veins is feasible and safe in VATS and reduces the risk of abrupt intraoperative bleeding and the chance of converting to open thoracotomy, and extends the indications of VATS lobectomy.
在电视辅助胸腔镜手术（VATS）中，肺叶切除并部分切除肺动脉目前仍是胸外科医生面临的一项挑战。我们感兴趣的是将开胸手术中的肺血管阻断技术引入电视辅助胸腔镜手术（VATS）操作中。在本研究中，我们报告了一种在VATS下同时阻断肺动脉和肺静脉以部分切除肺动脉的手术技术。2007年12月至2012年3月期间，7例非小细胞肺癌（NSCLC）患者使用该技术进行了肺叶切除并部分切除肺动脉。简而言之，我们不是在侵入癌灶区域的远端肺动脉上使用小夹子，而是用一根带子和Hem-o-lock夹代替血管夹来阻断保留的肺静脉，以防止回血，并为外科医生提供更好的视野。肺动脉和肺静脉的平均阻断时间分别为44.0±10.0分钟和41.3±9.7分钟。肺动脉的平均修复时间为25.3±13.7分钟。未发生并发症。没有患者显示重建血管有异常血流。肺动脉没有局部复发。总之，在VATS中阻断肺动脉和静脉的技术是可行且安全的，可降低术中突然出血的风险以及转为开胸手术的几率，并扩大了VATS肺叶切除的适应证。
