Tsunezuka Yoshio, Fujimori Hideki, Tanaka Nobuyoshi, Tanaka Nobuhiro
Department of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
Kyobu Geka. 2017 Feb;70(2):94-99.
Several thoracoscopic fissureless lobectomy techniques have been reported;however, the indications for the same remain controversial. One of the reasons for conversion to open lobectomy is the swelling or inflammation of lymph nodes between the lobar bronchus and the adjacent pulmonary artery. In this report, we advocate temporary segmental bronchus incision technique(T-BIT)and describe its application for lung cancer patients with fused fissures. T-BIT involves initial segmental bronchus incision before lobar bronchus stapling to safely dissect the lymph nodes between the lobar bronchus and the pulmonary artery. Eight patients who underwent thoracoscopic fissureless lobectomy with T-BIT between August 2014 and August 2016 were included in the study. Five patients underwent left upper lobectomy, one underwent left lower lobectomy, and 2 underwent right middle lobectomy. With T-BIT, complete peribronchial lymph node dissection was easily performed in all patients. There were no intraoperative complications, such as pulmonary artery bleeding or pulmonary injury. The postoperative chest tube drainage time was 2.5±0.5 days. Taken together, T-BIT appears useful for lymph node dissection in thoracoscopic fissureless lobectomy.
已有多种胸腔镜无裂叶切除术技术被报道；然而，其适应证仍存在争议。转为开胸叶切除术的原因之一是叶支气管与相邻肺动脉之间淋巴结的肿胀或炎症。在本报告中，我们提倡临时节段支气管切开技术（T-BIT），并描述其在融合裂患者肺癌中的应用。T-BIT包括在叶支气管吻合前先进行节段支气管切开，以安全地解剖叶支气管与肺动脉之间的淋巴结。本研究纳入了2014年8月至2016年8月期间接受T-BIT胸腔镜无裂叶切除术的8例患者。5例行左上叶切除术，1例行左下叶切除术，2例行右中叶切除术。采用T-BIT，所有患者均能轻松完成支气管周围淋巴结的完整清扫。无术中并发症，如肺动脉出血或肺损伤。术后胸腔闭式引流时间为2.5±0.5天。综上所述，T-BIT似乎有助于胸腔镜无裂叶切除术中的淋巴结清扫。
