Dowling R D, Keenan R J, Ferson P F, Landreneau R J
Department of Cardiothoracic Surgery, University of Pittsburgh, Pennsylvania.
Ann Thorac Surg. 1993 Sep;56(3):772-5. doi: 10.1016/0003-4975(93)90977-p.
Pulmonary lesions in patients with malignancy often require resection to provide prognostic information and to dictate further therapy. Metastasectomy may also favorably influence survival in select patients with favorable tumor histologies. Seventy-two patients with a history of malignancy and new lung lesions identified by high resolution computed tomography underwent thoracoscopic resection. The operative approach was with standard techniques using two or three trocar sites. Preoperative needle localization was used in 13 patients with small lesions that were not immediately subpleural. All target lesions were identified at thoracoscopy. Exploratory thoracoscopy was followed by parenchymal sparing wedge resection with the endoscopic stapler, the neodymium:yttrium-aluminum garnet laser, or both. Histologic analysis revealed metastatic disease in 63 patients and benign disease in 9 patients. The mean diameter of the lesions was 1.6 cm. The mean duration of chest tube drainage and postoperative hospital stay were 2.1 and 4.1 days, respectively. Thoracoscopic resection appears to be a valid approach for diagnostic resection of presumed metastases. The role of thoracoscopy in therapeutic metastasectomy remains to be defined.
恶性肿瘤患者的肺部病变通常需要切除以提供预后信息并指导进一步治疗。对于某些具有良好肿瘤组织学特征的患者，转移灶切除术也可能对生存产生有利影响。72例有恶性肿瘤病史且经高分辨率计算机断层扫描发现新的肺部病变的患者接受了胸腔镜切除术。手术方法采用标准技术，使用两到三个套管针穿刺点。13例小病变且不在胸膜下的患者术前采用了针定位。所有目标病变在胸腔镜检查时均被识别。探索性胸腔镜检查后，使用内镜缝合器、钕:钇铝石榴石激光或两者进行保留实质的楔形切除术。组织学分析显示63例为转移性疾病，9例为良性疾病。病变的平均直径为1.6厘米。胸腔引流管平均引流时间和术后住院时间分别为2.1天和4.1天。胸腔镜切除术似乎是诊断性切除疑似转移灶的有效方法。胸腔镜在治疗性转移灶切除术中的作用仍有待确定。
