Guo Zhao-hui, Kang Ming-qiang, Lin Ruo-bai, Zheng Wei, Zhu Yong, Zheng Bin, Xu Guo-bing, Chen Chun
Department of Thoracic Surgery, Fujian Medical University Union Hospital, NO.29, Xinquan Road, Fuzhou, 350000, Fujian, China.
World J Surg. 2014 Oct;38(10):2645-51. doi: 10.1007/s00268-014-2598-8.
Complete video-assisted thoracoscopic surgery (c-VATS) for left upper lobectomy is difficult due to the branching pattern of the left pulmonary artery.
Our purpose was to report outcomes of a modified technique of c-VATS left upper lobectomy.
We retrospectively compared the outcomes of 83 patients with stage I/II non-small-cell lung cancer (NSCLC) who received left upper lobectomy between 2008 and 2011; 32 underwent conventional c-VATS and 50 received modified c-VATS. In the modified procedure, the order in which hilum of lung was treated was from the lingular segmental artery to the superior pulmonary vein to the bronchus, and then finally the pulmonary artery.
The mean patient age was 63.6 ± 8.4 years, and no differences were observed in age, gender, and largest tumor diameter between the two groups. No conversion occurred in either group. The surgical time for modified c-VATS was significantly shorter than that for conventional c-VATS (210 vs. 270 min, p < 0.001). Drainage time after surgery and length of hospitalization for the modified c-VATS group were significantly less than those for the conventional group (drainage 3 vs. 4 days, respectively, p = 0.041; length of hospitalization 7 versus 12 days, respectively; p < 0.001). Surgical margins were clear in all cases. Four (8.0 %) complications occurred in the modified procedure group compared with ten (31.3 %) in the conventional group (p = 0.015).
This new technique offers shorter surgical and postoperative drainage time, shorter hospital stays, and fewer complications than conventional c-VATS upper left lobectomy.
由于左肺动脉的分支模式，完全胸腔镜辅助下左上叶切除术（c-VATS）具有挑战性。
我们旨在报告改良c-VATS左上叶切除术的技术效果。
回顾性比较2008年至2011年间接受左上叶切除术的83例I/II期非小细胞肺癌（NSCLC）患者的治疗效果；32例行传统c-VATS，50例行改良c-VATS。在改良手术中，处理肺门的顺序是从舌段动脉到肺上静脉再到支气管，最后是肺动脉。
患者平均年龄为63.6±8.4岁，两组在年龄、性别和最大肿瘤直径方面无差异。两组均未发生中转开胸。改良c-VATS的手术时间明显短于传统c-VATS（210分钟对270分钟，p<0.001）。改良c-VATS组术后引流时间和住院时间明显短于传统组（引流时间分别为3天对4天，p = 0.041；住院时间分别为7天对12天，p<0.001）。所有病例手术切缘均清晰。改良手术组发生4例（8.0%）并发症，传统组发生10例（31.3%）（p = 0.015）。
与传统c-VATS左上叶切除术相比，这项新技术缩短了手术时间和术后引流时间，缩短了住院时间，减少了并发症。
