Ngodngamthaweesuk Montien, Attanawanich Sukasom, Kijjanon Narumol
Division of Thoracic Surgery, Department of Surgery, Ramathibodi Hospital, Mahidol University Bangkok, Thailand.
J Med Assoc Thai. 2013 Jul;96(7):819-23.
Although the public perceives video-assisted thoracic surgery (VATS) as advantageous because it is less invasive than a standard thoracotomy There are questioned the safety of VATS lobectomy and its adequacy as a cancer operation. This study is reviewed to assess this issue.
This retrospective study was performed between January 2009 and June 2011 in 58 patients who underwent VATS for a standard anatomic lobectomy with lymph node sampled or dissection for lung cancer 43 women (74%) and 15 men (26%) and mean age 60.28+/-11.14 years. None of this study group had any pleural effusion or pleural dissemination.
The most symptom and sign of patients with lung cancer were normal [48 cases (83%), 54 cases (93%) respectively]. The most risk factor was smoking [12 cases (20%)]. The most lobectomy of VATS lobectomy was right upper lobectomy [17 cases (29%)] and the longest duration of VATS lobectomy was left upper lobectomy was 237.00+/-38.60 minutes. Thirty-one patients (53.4%) were adenocarcinoma. The VATS lobectomy was adequate for lung cancer surgery because malignant cells were not found from cytologic study of pleural lavages. The conversion rate from VATS to standard thoracotomy lobectomy was seven cases (12%), which the common causes were pleural symphysis and inadequate one lung ventilation. The postoperative courses showed minimal blood transfusion (0.11+/-0. 37ū), intensive care unit (ICU) stay (0.61+/-0.56 days) and intercostal drainage (ICD) duration (6.10+/-5.79 days). There were no intra-and post-operative death. Seven cases (12%) had many complications; the most complication was bacteria pneumonia. A case needed re-thoracotomy due to medical treatment failure for chylothorax.
VATS lobectomy (anatomic lobectomy and lymph nodes sampled or dissection)for lung cancer can be performed with low morbidity and no mortality.
尽管公众认为电视辅助胸腔镜手术（VATS）具有优势，因为它比标准开胸手术的侵入性小，但VATS肺叶切除术的安全性及其作为癌症手术的充分性受到质疑。本研究旨在评估这一问题。
这项回顾性研究于2009年1月至2011年6月对58例行VATS标准解剖性肺叶切除术并进行淋巴结采样或清扫的肺癌患者进行，其中女性43例（74%），男性15例（26%），平均年龄60.28±11.14岁。该研究组中无一例有胸腔积液或胸膜播散。
肺癌患者最常见的症状和体征分别为正常[48例（83%），54例（93%）]。最主要的危险因素是吸烟[12例（20%）]。VATS肺叶切除术中最常见的是右上叶切除术[17例（29%）]，VATS肺叶切除术持续时间最长的是左上叶切除术，为237.00±38.60分钟。31例（53.4%）为腺癌。VATS肺叶切除术对于肺癌手术是充分的，因为胸腔灌洗细胞学检查未发现恶性细胞。VATS转为标准开胸肺叶切除术的转化率为7例（12%），常见原因是胸膜粘连和单肺通气不足。术后过程显示输血极少（0.11±0.37升）、重症监护病房（ICU）停留时间短（0.61±0.56天）和肋间引流（ICD）持续时间短（6.10±5.79天）。无术中及术后死亡。7例（12%）有多种并发症；最常见的并发症是细菌性肺炎。1例因乳糜胸内科治疗失败需再次开胸。
VATS肺叶切除术（解剖性肺叶切除术及淋巴结采样或清扫）治疗肺癌可实现低发病率且无死亡率。
