Asamura H, Nakayama H, Kondo H, Tsuchiya R, Naruke T
Division of Thoracic Surgery, National Cancer Center Hospital Japan, Cho-ku, Tokyo.
Chest. 1997 Apr;111(4):1101-5. doi: 10.1378/chest.111.4.1101.
Video-assisted lobectomy for pulmonary malignancy seems to have potential merits, especially in compromised patients such as the elderly. This study was undertaken to assess the feasibility of this new approach in this special age group.
Video-assisted lobectomy was attempted in eight patients older than 78 years of age with preoperatively diagnosed T1N0 or T2N0 lung carcinomas of peripheral origin. In one patient with squamous cell carcinoma, the tumor was diagnosed after surgery as metastasis from tongue carcinoma. The patients ranged in age from 78 to 85 years (average, 81.3 years).
The procedure was completed successfully in six patients (75%), while the other two patients underwent lobectomy after conversion to open thoracotomy because of bleeding from the pulmonary artery at the hilum in one and extensive pleural adhesions in another. Among the six patients who underwent video-assisted lobectomy, there were no operative deaths or serious complications attributable to this technique, although two patients had prolonged air leakage for 7 and 11 days, respectively.
This approach, which is feasible even in patients older than 80 years, is likely to offer a benefit to such patients if they are selected properly. During this procedure, the possibility of wound extension in case of an intraoperative accident must always be borne in mind, especially in elderly patients. The advantage of this approach remains undetermined in this special age group.
电视辅助肺叶切除术治疗肺部恶性肿瘤似乎有潜在优势，尤其对于老年等身体状况不佳的患者。本研究旨在评估这种新方法在这一特殊年龄组中的可行性。
对8例年龄超过78岁、术前诊断为外周型T1N0或T2N0肺癌的患者尝试进行电视辅助肺叶切除术。1例鳞状细胞癌患者术后诊断为舌癌转移。患者年龄在78至85岁之间（平均81.3岁）。
6例患者（75%）手术成功完成，另外2例患者因1例肺门处肺动脉出血和另1例广泛胸膜粘连，转为开胸肺叶切除术后完成手术。在接受电视辅助肺叶切除术的6例患者中，虽有2例分别出现了7天和11天的持续性漏气，但无手术死亡或因该技术导致的严重并发症。
这种方法即使在80岁以上患者中也是可行的，如果选择得当，可能会使这类患者受益。在此手术过程中，尤其是老年患者，必须始终牢记术中发生意外时伤口扩大的可能性。在这一特殊年龄组中，这种方法的优势尚不确定。
