Kirby T J, Rice T W
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44195.
Ann Thorac Surg. 1993 Sep;56(3):784-6. doi: 10.1016/0003-4975(93)90980-v.
The various applications of video-assisted thoracic surgery (VATS) have rapidly expanded in the past 2 years to include may straightforward and technically unsophisticated procedures. We report our experience in 23 patients in which a VATS lobectomy was attempted. Preoperative staging, which included a computed tomographic scan of the head, chest, and abdomen as well as a bone scan, revealed that these patients with primary non-small cell lung carcinomas were in clinical stage I. All patients had adequate pulmonary reserve to tolerate a lobectomy. Further staging was accomplished by invasive means in all patients, and consisted of mediastinoscopy and, when indicated, mediastinotomy. Three patients were subsequently found to have N2 disease and were excluded from the study. In 15 of the remaining 20 patients, a successful VATS lobectomy was accomplished. There were no major intraoperative complications and all patients recovered uneventfully. Their mean hospital stay was 5.5 +/- 1.9 days. We conclude that VATS lobectomy is technically possible in this good-risk group of patients with early clinical stage I lung cancer. However, as with all VATS procedures, the advantages of this approach over more conventional surgical techniques need to be addressed in randomized trials. Our experience also indicates that considerable improvements are necessary, both in terms of the imaging and the instrumentation, to allow major procedures such as pulmonary lobectomy to be safely and expeditiously performed using a VATS approach.
在过去两年中，电视辅助胸腔镜手术（VATS）的各种应用迅速扩展，涵盖了许多简单且技术要求不高的手术。我们报告了23例尝试进行VATS肺叶切除术患者的经验。术前分期包括头部、胸部和腹部的计算机断层扫描以及骨扫描，结果显示这些原发性非小细胞肺癌患者处于临床I期。所有患者都有足够的肺储备以耐受肺叶切除术。所有患者均通过侵入性手段进一步分期，包括纵隔镜检查，必要时进行纵隔切开术。随后发现3例患者有N2期疾病，被排除在研究之外。在其余20例患者中的15例中，成功完成了VATS肺叶切除术。术中无重大并发症，所有患者均顺利康复。他们的平均住院时间为5.5±1.9天。我们得出结论，对于早期临床I期肺癌的这一低风险患者群体，VATS肺叶切除术在技术上是可行的。然而，与所有VATS手术一样，这种方法相对于更传统手术技术的优势需要在随机试验中加以探讨。我们的经验还表明，在成像和器械方面都需要有相当大的改进，以使诸如肺叶切除术等大型手术能够使用VATS方法安全、迅速地进行。
