胸腔镜辅助肺切除术——墨尔本经验。

Video-assisted thoracoscopic pulmonary resections - The Melbourne experience.

机构信息

Director of Surgical Oncology, St Vincent's Hospital, Melbourne, Australia; ; Clinical Associate Professor, University of Melbourne Department of Surgery, St Vincent's Hospital, Melbourne, Australia; ; Thoracic Surgical Lead, Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.

出版信息

Ann Cardiothorac Surg. 2012 May;1(1):11-5. doi: 10.3978/j.issn.2225-319X.2012.04.01.

DOI:10.3978/j.issn.2225-319X.2012.04.01

PMID:23977458

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3741712/

Abstract

BACKGROUND

Despite its privileged economic and educational place in the world, Melbourne was relatively slow to embrace video-assisted thoracic surgery (VATS) for lobectomy. The initial driver of this was Professor C Peter Clarke at the Austin Hospital at the beginning of the new millennium. His legacy was carried on by his apprentice, but at St Vincent's Hospital. After a period of slow development, it became the procedure of choice from 2005, and began to filter sporadically to other hospitals from 2010.

METHODS

This paper details the historical development, techniques and results of 343 VATS pulmonary resections (including lobectomies, sub-lobar anatomical resections, sleeve resections, bi-lobectomies and pneumonectomies).

RESULTS

In-hospital and 30-day mortality was 2.0% and 5-year survival for all stages of NSCLC was 70%. Over 36% of patients were stage II-III using the new 7(th) revision TNM staging system. The conversion to thoracotomy rate was 4.7%. The estimated learning curve for this experience VATS lobectomy appears to be in the range of 15-20 cases. In this series, the same lymph node dissection or sampling was attempted and usually achieved as would have occurred at thoracotomy.

CONCLUSIONS

The results confirm the findings of other large case series that the benefits of a minimally invasive approach are achieved without compromising the long-term survival.

摘要

背景

尽管墨尔本在世界上享有优越的经济和教育地位，但它相对较晚才开始采用电视辅助胸腔镜手术（VATS）进行肺叶切除术。这一进程的最初推动者是千禧年初在奥克斯丁医院的教授 C Peter Clarke。他的衣钵由他的门徒在圣文森特医院传承。在经历了一段时间的缓慢发展后，VATS 从 2005 年开始成为首选手术方式，并从 2010 年开始间歇性地在其他医院采用。

方法

本文详细介绍了 343 例 VATS 肺切除术（包括肺叶切除术、亚肺叶解剖性切除术、袖状切除术、双肺叶切除术和全肺切除术）的历史发展、技术和结果。

结果

院内死亡率和 30 天死亡率分别为 2.0%和所有 NSCLC 分期的 5 年生存率为 70%。使用新的第 7 版 TNM 分期系统，超过 36%的患者为 II-III 期。中转开胸率为 4.7%。对于这种经验丰富的 VATS 肺叶切除术，估计学习曲线范围在 15-20 例之间。在本系列中，尝试并通常实现了与开胸手术相同的淋巴结清扫或取样。