Patrizi I, Capomagi A, Cappelluti G, Maffia L, De Sanctis A, Boccoli G, La Rocca R
Unità Operativa di Chirurgia Generale e Ricerca Chirurgica, Ancona.
Minerva Chir. 1996 Apr;51(4):187-93.
Video-endoscopic surgery developed from laparoscopic removal of the gallbladder and can be used for treatment of certain disease processes of the chest. The major application of this technique is the performance of pulmonary resections (lobectomies and pneumonectomies). Video-thoracoscopic lobectomy requires general anesthesia with a double lumen intubation. After collapse of the involved lung, two intercostal incisions are performed (the first one in seventh space, mid axillary and the second one in fifth space, below the angle of the scapula) and an additional mini-thoracotomy (submammillary in the fifth space) is made. The lobar arteries, veins and bronchus are occluded with an automatic endoscopic stapling device. Seven cases of pulmonary neoplasms (stage I) have been treated by video pulmonary lobectomy (3 right lower lobectomies, 2 right upper lobectomies, 2 left lower lobectomies). Two procedures have been converted for an advanced neoplastic stage that required a radical pneumonectomy and an uncontrolled bleeding. This new procedure has the advantage of greatly reducing the pain and ventilatory disability associated with conventional open thoracic surgery.
电视胸腔镜手术起源于腹腔镜胆囊切除术，可用于治疗胸部的某些疾病。该技术的主要应用是进行肺切除术（肺叶切除术和全肺切除术）。电视胸腔镜肺叶切除术需要全身麻醉并插入双腔气管导管。患侧肺萎陷后，做两个肋间切口（第一个在腋中线第七肋间，第二个在肩胛下角下方第五肋间），并做一个额外的小切口（第五肋间乳晕下切口）。用自动内镜缝合器阻断肺叶动静脉和支气管。7例I期肺肿瘤患者接受了电视胸腔镜肺叶切除术（3例右下肺叶切除术，2例右上肺叶切除术，2例左下肺叶切除术）。2例因肿瘤进展需要行根治性全肺切除术及术中出血难以控制而中转开胸。这种新手术的优点是大大减轻了与传统开胸手术相关的疼痛和通气功能障碍。
