全胸腔镜肺叶切除治疗支气管扩张症

目的探讨全胸腔镜下肺叶切除治疗支气管扩张症的安全性、可行性和有效性。方法回顾性分析我中心2007年4月～2009年11月完成的24例全胸腔镜肺叶切除手术治疗支气管扩张症的临床资料。全胸腔镜下解剖性肺叶切除,不牵开肋骨,以切割缝合器分别处理肺血管和支气管。如遇严重粘连或出血等则中转开胸手术。记录手术时间、出血量、术后带管时间以及并发症等。结果全组中2例(8.3%)因为胸腔内粘连重,叶间裂分化差或肺门处严重粘连并有大量迂曲扩张的血管,镜下处理困难而中转开胸行VATS辅助小切口手术。余22例在全胸腔镜下完成,肺切除范围包括右肺上叶1例,右肺中叶1例,右肺下叶3例,左肺上叶2例,左肺下叶13例,左肺下叶+左肺上叶舌段1例,左肺下叶+右肺中叶1例。手术时间(173.6±57.1)min(80～280min),出血量(173.9±65.9)ml(50～300ml),术后带管时间(6.1±3.8)d(2～19d),术后住院时间(8.6±3.9)d(4～22d)。术后病理均符合支气管扩张症改变。无围手术期死亡。并发症4例,均为肺持续漏气7d,引流7～19d后自愈拔除胸腔引流管。全组随访1～31个月,平均13.7月,其中13例12个月。15例(62.5%)术后咳痰或咯血症状完全消失,7例(29.2%)痰量明显减少,但仍间断有咳痰或咯血等症状。2例(8.3%)咯血量或痰量较前无明显变化。结论全胸腔镜肺叶切除术是治疗支气管扩张症的一种安全有效的方法 。

Complete Video-assisted Thoracoscopic Lobectomy for Bronchiectasis

Objective To evaluate the feasibility,safety and efficacy of complete video-assisted thoracoscopic surgery（cVATS）for lobectomy in the management of bronchiectasis.Methods Between April 2007 and November 2009,a total of 24 patients（14 female and 10 male,aged 25 to 58 years with a mean of 42.4）underwent VATS for lobectomy in our center.The lobectomy was carried out anatomically without separating the ribs.Pulmonary vessels and bronchus were then dissected by endo-cutters.Conversion to a thoracotomy took place if severe adhesion or bleeding was encountered.Results cVATS lobectomy was successfully performed in 22 patients,including 1 right upper lobectomy,1 middle lobe,3 right lower lobe,2 left upper lobe,13 left lower lobe,1 left lower lobe plus lingular segment,and 1 left lower lobe plus right middle lobe.Conversion to open surgery occurred in 2 patients（8.3%）due to severe adhesion,poor differentiation of the fissure and the proliferation of tortuous vessels at the hilus.The mean time for cVATS was（173.6±57.1）min（ranged 80 to 280 min）,during which,a mean of（173.9±65.9）ml blood loss（ranged from 50 to 300 ml）was collected.In our patients,the mean chest tube duration was（6.1±3.8）days（ranged 2 to 19 days）and the mean postoperative hospital stay was（8.6±3.9）days（ranged 4 to 22 days）.No mortality or severe complications occurred peri-operatively.Postoperative pathological examination confirmed the diagnosis of bronchiectasis in all of the patients.After the operation,4 patients developed continuous pulmonary leakage for over 7 days;chest drainage was thus carried out and the patients were cured in 7 to 19 days.This series was followed up for 1 to 31 months with a mean of 13.7 months（over 12 months in 13 cases）.During the period,15 patients（62.5%）relieved symptoms completely,7（29.2%）were improved with markedly decreased volume of sputum,and 2 patients（8.3%）was not improved.Conclusion cVATS is safe and effective for lobectomy in patients with bronchiectasis.