胸腔镜辅助全肺切除术：前入路。
Video-assisted thoracoscopic pneumonectomy: the anterior approach.
机构信息
The Affiliated Hospital of the Guangdong Medical College, Zhanjiang 524001, China.
出版信息
J Thorac Dis. 2013 Dec;5(6):855-61. doi: 10.3978/j.issn.2072-1439.2013.11.20.
BACKGROUND
Video-assisted thoracoscopic surgery (VATS) lobectomy is now a well-accepted way to perform a minimally invasive lobectomy. VATS lobectomy is different from the conventional surgery. Different incisions, instruments and camera positions have also been described in the past two decades. There are no fixed patterns in VATS lobectomy. We here describe our method for fissure-based VATS lobectomy using an anterior approach. The aim of this paper is to show our technique for VATS lobectomy and our experience and outcomes obtained.
METHODS
A 57-year-old man, who was admitted to the Affiliated Hospital of the Guangdong Medical College, had coughing up blood tinged sputum, right chest pain for one month. Thoracic CT imaging revealed a 22 mm × 22 mm × 20 mm, T1bN1M0 lesion in the right lower lobe. The patient for clinical stage II non-small cell lung cancer underwent VATS lobectomy by using an anterior approach on January 2013.
RESULTS
Total volume of chest tube drainage after operation was 450 mL, intraoperative blood loss was 80 mL, operation time was 105.8 min, chest tube duration was three days, length of postoperative hospital stay was eight days. Follow-up no recurrence and metastasis for six months.
CONCLUSIONS
The main advantages of the anterior approach in our experience are easy to deal with the absence or incomplete fissure by the "tunneling" approach. In addition, the mediastinal node packets are clearly seen, allowing thorough lymphadenectomy. Therefore, VATS lobectomy by the anterior approach is a safe, feasible procedure.
背景
电视辅助胸腔镜手术（VATS）肺叶切除术现在是一种公认的微创肺叶切除术方法。VATS 肺叶切除术与传统手术不同。在过去的二十年中，也已经描述了不同的切口、器械和摄像头位置。VATS 肺叶切除术没有固定的模式。我们在这里描述了一种基于裂隙的使用前入路的 VATS 肺叶切除术方法。本文的目的是展示我们的 VATS 肺叶切除术技术以及我们获得的经验和结果。
方法
一名 57 岁男性，因咯血痰、右侧胸痛 1 个月就诊于广东医学院附属医院。胸部 CT 影像学显示右肺下叶有一个 22mm×22mm×20mm 的 T1bN1M0 病变。该患者因临床分期为 II 期非小细胞肺癌，于 2013 年 1 月采用前入路行 VATS 肺叶切除术。
结果
术后胸腔引流管总引流量为 450ml，术中出血量为 80ml，手术时间为 105.8min，胸腔引流管留置时间为 3 天，术后住院时间为 8 天。随访 6 个月无复发和转移。
结论
在我们的经验中，前入路的主要优点是通过“隧道”方法更容易处理裂隙的缺失或不完整。此外，纵隔淋巴结包块清晰可见，可进行彻底的淋巴结清扫。因此，前入路的 VATS 肺叶切除术是一种安全可行的方法。
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