Keenan R J, Landreneau R J, Hazelrigg S R, Ferson P F
Section of Thoracic Surgery, University of Pittsburgh, Pa. 15213, USA.
J Thorac Cardiovasc Surg. 1995 Aug;110(2):363-7. doi: 10.1016/S0022-5223(95)70231-8.
Since January 1991, we have performed 79 video-assisted neodymium: yttrium-aluminum-garnet laser resections for pulmonary nodular or interstitial disease. Pathologic examination demonstrated malignancy in 59 patients (32 primary and 27 metastatic), benign nodules in 11, interstitial processes in seven, and granulomatous disease in two. There were 39 men and 40 women with a mean age of 63.4 +/- 12.5 years. Thirty-nine patients underwent resection with the neodymium:yttrium-aluminum-garnet laser alone and 40 had lesions resected with a combination of laser and endoscopic stapling. Laser excision was performed for lesions deep in the substance of the lung or on its effaced surface; both are locations that make stapling alone difficult. Fifteen of 32 patients with a diagnosis of primary lung malignancy underwent open anatomic resections. Pulmonary reserves of the other 17 patients were inadequate for further resection. Operative time, duration of chest tube placement, length of hospital stay, and complication rate were compared with those for 72 patients undergoing video-assisted thoracic surgical resection of nodules with staplers alone. Although operative time for laser-assisted procedures was longer (p < 0.05), there were no differences in duration of chest tube placement or hospital stay compared with stapled resections. The complication rate for laser-treated cases was not higher than for stapled resections and consisted primarily of air leaks lasting 2 to 7 days. The neodymium:yttrium-aluminum-garnet laser is a safe and precise primary or adjunctive tool for video-assisted thoracic surgical pulmonary resection.
自1991年1月以来，我们已对79例肺结节或间质性疾病患者进行了电视辅助钕：钇铝石榴石激光切除术。病理检查显示59例为恶性（32例原发性和27例转移性），11例为良性结节，7例为间质性病变，2例为肉芽肿性疾病。患者中男性39例，女性40例，平均年龄63.4±12.5岁。39例患者仅接受钕：钇铝石榴石激光切除术，40例患者的病变通过激光和内镜吻合器联合切除。激光切除用于肺实质深部或表面模糊的病变；这两种位置单独使用吻合器都很困难。32例诊断为原发性肺癌的患者中有15例行开放性解剖切除术。其他17例患者的肺储备功能不足以进行进一步切除。将手术时间、胸管放置时间、住院时间和并发症发生率与72例仅用吻合器进行电视辅助胸外科结节切除术的患者进行比较。虽然激光辅助手术的手术时间较长（p<0.05），但与吻合器切除术相比，胸管放置时间或住院时间没有差异。激光治疗病例的并发症发生率不高于吻合器切除术，主要为持续2至7天的气胸。钕：钇铝石榴石激光是电视辅助胸外科肺切除术中一种安全、精确的主要或辅助工具。
