Szántó Zoltán, Kovács Ottó, Parham Choroumzadeh Dashti, Lippai Norbert, Csőszi Tibor, Urbán Dániel
Általános és Mellkassebészeti Osztály, Jász-Nagykun-Szolnok Megyei Hetényi Géza Kórház-Rendelőintézet 5000 Szolnok, Tószegi u. 21.
Anaesthesiologiai és Intenzív Osztály, Jász-Nagykun-Szolnok Megyei Hetényi Géza Kórház-Rendelőintézet Szolnok.
Magy Seb. 2019 Sep;72(3):98-102. doi: 10.1556/1046.72.2019.3.2.
: Authors present their 7-year experience since the introduction of minimal-invasive (VATS) lobectomies for lung cancer in regard to their surgical technique, results and oncological follow-up. 173 VATS lobectomies were performed between June 2011 and December 2017, 105 men and 68 women. The mean age of patients was 64.1 years. Duration of surgery was 130 minutes on average. Conversion to thoracotomy was required in 8 cases (3 bleedings, 3 pulmonary vessel lymph node infiltrations, 2 bronchial suture insufficiencies). Twenty persistent air leaks developed postoperatively, requiring 10 re-drainages and 10 re-operations: 7 re-VATS and 3 thoracotomies. Two hematomas were evacuated by re-VATS, 1 postoperative atrial fibrillation required cardioversion. There were no perioperative deaths. The 164 malignant cases were: 110 adenocarcinomas, 32 squamous cell carcinomas, 6 small cell neuroendocrine carcinomas, 4 undifferentiated carcinomas, 4 carcinoid tumours, 1 synchronous adenocarcinoma and squamous cell carcinoma, 1 synchronous adenocarcinoma and small cell carcinoma, 1 carcinosarcoma and 5 metastasis from other primary tumours. 118 patients received adjuvant chemotherapy. Tumour staging distribution was: IA 40, IB 53, IIA 29, IIB 16 and IIIA 21 cases. During an average follow-up time of 19.5 months, 9 local tumour recurrence and 27 distant metastasis evaluated, of which 11 were pulmonary (3 multiplex), 10 bone, 6 cerebral, 3 hepatic (1 multiplex), and 3 suprarenal gland. Our results correlate with published literature. During the period of this review, VATS lobectomies became a routine surgical technique in our department. Our experience proved that axillary thoracotomy is an advantage to learn the anterior VATS lobectomy technique.
作者介绍了自开展肺癌微创（电视辅助胸腔镜手术，VATS）肺叶切除术以来7年的经验，包括手术技术、结果及肿瘤学随访情况。2011年6月至2017年12月期间共进行了173例VATS肺叶切除术，其中男性105例，女性68例。患者平均年龄为64.1岁。手术平均时长为130分钟。8例（3例出血、3例肺血管淋巴结浸润、2例支气管缝合不足）需要转为开胸手术。术后出现20例持续性漏气，需要进行10次再次引流和10次再次手术：7次再次VATS手术和3次开胸手术。通过再次VATS手术清除了2例血肿，1例术后房颤需要进行心脏复律。无围手术期死亡病例。164例恶性病例包括：110例腺癌、32例鳞状细胞癌、6例小细胞神经内分泌癌、4例未分化癌、4例类癌肿瘤、1例同步性腺癌和鳞状细胞癌、1例同步性腺癌和小细胞癌、1例癌肉瘤以及5例其他原发性肿瘤的转移瘤。118例患者接受了辅助化疗。肿瘤分期分布为：IA期40例、IB期53例、IIA期29例、IIB期16例和IIIA期21例。在平均19.5个月的随访期内，评估发现9例局部肿瘤复发和27例远处转移，其中11例为肺部转移（3例为多发）、10例为骨转移、6例为脑转移、3例为肝转移（1例为多发）以及3例为肾上腺转移。我们的结果与已发表的文献相符。在本回顾期内，VATS肺叶切除术在我们科室已成为常规手术技术。我们的经验证明，腋下开胸手术有助于学习前入路VATS肺叶切除术技术。
