Kohno T, Murakami T, Wakabayashi A
Department of Surgery, University of California, Irvine.
J Thorac Cardiovasc Surg. 1993 Apr;105(4):729-31.
We conducted this study in an attempt to investigate whether anatomic lobectomy can be performed through a thoracoscope. Twelve lower (seven left and five right) and six left upper lobectomies were done in 17 pigs weighing 60 to 90 kg. With the use of general anesthesia and one-lung ventilation, a thoracoscope and operating instruments were inserted through four or five trocars. First, the incomplete fissure was bluntly dissected with specially designed cotton-tipped dissectors and divided by an electrocautery spatula or sapphire contact-tip neodymium: yttrium aluminum garnet laser probe. The pulmonary artery and its branches were similarly dissected. Two ligatures were passed around the vessels by endoscopic right-angle clamps and tied by means of an extracorporeal tying technique. The vessels were clipped and divided. In two animals, a hidden branch of the pulmonary artery was inadvertently cut. Bleeding was readily controlled with the dissector until metal clips could be applied. The bronchus was similarly dissected and divided and the proximal stump was closed with sutures. The pulmonary vein was dissected bluntly by the same technique and divided. The excised lobe was placed in a plastic bag and pulled out through one of the trocar holes after the hole had been enlarged to 3 cm. Blood loss was minimal. In conclusion, anatomic lobectomy of the lung by means of thoracoscopy was feasible in the pig.
我们进行这项研究旨在调查是否可以通过胸腔镜进行解剖性肺叶切除术。对17头体重60至90千克的猪实施了12例下叶（7例左侧和5例右侧）和6例左上叶切除术。采用全身麻醉和单肺通气，通过四或五个套管针插入胸腔镜和手术器械。首先，用特制的棉头解剖器钝性分离不完全裂，并用高频电刀铲或蓝宝石接触式钕：钇铝石榴石激光探头进行分割。肺动脉及其分支也以同样方式进行解剖。用内镜直角夹在血管周围绕过两道结扎线，并通过体外结扎技术进行结扎。血管夹闭并切断。在两只动物中，一条肺动脉的隐蔽分支被意外切断。在用解剖器控制出血后，直至能够应用金属夹。支气管也以同样方式进行解剖和切断，近端残端用缝线缝合。肺静脉用相同技术钝性解剖并切断。切除的肺叶置于塑料袋中，在将套管针孔扩大至3厘米后，通过其中一个孔拉出。失血极少。总之，猪通过胸腔镜进行肺的解剖性肺叶切除术是可行的。
