Rieger R, Woisetschläger R, Schinko H, Wayand W
2nd Department of Surgery, Linz General Hospital, Austria.
Thorac Cardiovasc Surg. 1993 Jun;41(3):152-5. doi: 10.1055/s-2007-1013844.
The increasing experience with minimally invasive surgery and advances in endoscopic equipment have expanded the role of thoracoscopy to include thoracoscopic pulmonary resections. In 11 patients we have evaluated the technical feasibility of thoracoscopic wedge resection of single peripheral lung lesions. In 8 patients the lesion could be exactly identified by thoracoscopy and be effectively resected using an automatic endoscopic stapler. All lesions were located within the outer third of the lung parenchyma with a maximum distance of 1.4 cm between lesion and visceral pleura. Mean diameter of the nodules was 1.9 cm and ranged from 1.0 to 4.1 cm. Histological analysis revealed completely excised tuberculomas in 4, carcinomas in 2, hamartoma in 1, and localised fibrosis in one patient. In 3 patients the thoracoscopic approach was unsuccessful because of difficulty in identifying the lesion or impossibility of achieving a reliable assessment of the intraparenchymal extension of the tumor. In conclusion, thoracoscopic wedge resection is helpful for the diagnostic and therapeutic management of peripheral lung lesions in carefully selected patients. Continued experience is necessary to be able to establish reliable criteria to assess which types of lung lesion can be excised safely and effectively by videothoracoscopy.
随着微创手术经验的不断积累以及内镜设备的进步，胸腔镜的作用已得到扩展，包括胸腔镜肺切除术。我们对11例患者评估了胸腔镜楔形切除单个外周肺病变的技术可行性。8例患者的病变可通过胸腔镜准确识别，并使用自动内镜缝合器有效切除。所有病变均位于肺实质外三分之一内，病变与脏层胸膜之间的最大距离为1.4 cm。结节的平均直径为1.9 cm，范围为1.0至4.1 cm。组织学分析显示，4例为完全切除的结核瘤，2例为癌，1例为错构瘤，1例为局限性纤维化。3例患者因难以识别病变或无法对肿瘤的实质内扩展进行可靠评估，胸腔镜手术未成功。总之，胸腔镜楔形切除对精心挑选的患者外周肺病变的诊断和治疗管理有帮助。需要持续积累经验以建立可靠标准，来评估哪些类型的肺病变可通过电视胸腔镜安全有效地切除。
