• 復(fù)旦大學(xué)附屬中山醫(yī)院胸外科，上海 200032;

目的 　評估胸腔鏡解剖性肺段切除術(shù)治療外周型早期肺癌、肺轉(zhuǎn)移瘤和肺良性疾病的可行性和安全性。方法 　回顧性分析 2008年 3月至 2011年 11月復(fù)旦大學(xué)附屬中山醫(yī)院行胸腔鏡解剖性肺段切除術(shù) 20例患者的臨床資料，其中男 10例，女 10例；平均年齡 58.0（14～ 86）歲。切口選擇3孔法。肺段動(dòng)脈、靜脈使用 Hem-o-lok或直線型切割合器處理，肺段支氣管及段間水平均使用直線型切割縫合器處理。分析手術(shù)效果和安全性。結(jié)果 　20例患者成功施行了胸腔鏡解剖性肺段切除術(shù)，無中轉(zhuǎn)開胸，無中轉(zhuǎn)肺葉切除，無圍術(shù)期死亡，無圍術(shù)期并發(fā)癥。術(shù)后組織病理學(xué)診斷示肺癌 10例，肺轉(zhuǎn)移瘤 3例，肺良性疾病 7例。平均手術(shù)時(shí)間 133.0（90～ 240）min，平均出血量 85.0（50～ 200）ml，術(shù)后平均胸腔引流管留置時(shí)間 3.2（2～ 7）d，術(shù)后平均住院時(shí)間 6.7（4～ 11）d。結(jié)論 　胸腔鏡解剖性肺段切除術(shù)安全可行，可以選擇性應(yīng)用于Ⅰa期肺癌或者不易行肺楔形切除術(shù)的肺轉(zhuǎn)移瘤和肺良性疾病患者。

引用本文： 林宗武,蔣偉,王群等. 胸腔鏡解剖性肺段切除術(shù)20例臨床分析. 中國胸心血管外科臨床雜志, 2012, 19(3): 270-273. doi: 復(fù)制

1. 　Churchill ED, Belsey R. Segmental pneumonectomy in bronchiectasis： The lingula segment of the left upper lobe. Ann Surg, 1939, 109 （4）： 481-499.
2. 　Bonfils-Roberts EA, Clagett OT. Contemporary indications for pulmonary segmental resections. J Thorac Cardiovasc Surg, 1972, 63 （3）： 433-438.
3. 　Jensik RJ, Faber LP, Milloy FJ, et al. Segmental resection for lung Cancer. a fifteen-year experience.J Thorac Cardiovasc Surg, 1973, 66（4）： 563-572.
4. 　Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung Cancer. Ann Thorac Surg, 1995, 60 （3）： 615-623.
5. 　Fernando HC, Santos RS, Benfield JR, et al. Lobar and sublobar resection with and without brachytherapy for small stage IA non-small cell lung Cancer. J Thorac Cardiovasc Surg, 2005, 129 （2）： 261-267.
6. 　Okumura M, Goto M, Ideguchi K, et al. Factors associated with outcome of segmentectomy for non-small cell lung cancer： long-term follow-up study at a single institution in Japan. Lung Cancer, 2007, 58 （2）： 231-237.
7. 　Okada M, Mimura T, Ikegaki J, et al. A novel video-assisted anatomic segmentectomy technique： selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. Thorac Cardiovasc Surg, 2007, 133 （3）： 753-758.
8. 　Watanabe A, Ohori S, Nakashima S, et al. Feasibility of video-assisted thoracoscopic surgery segmentectomy for selected peripheral lung carcinomas. Eur J Cardiothorac Surg, 2009, 35 （5）： 775-780.
9. 　Sugi K, Kobayashi S, Sudou M, et al. Long-term prognosis of video-assisted limited surgery for early lung cancer. Eur J Cardiothorac Surg, 2010, 37 （2）：456-460.
10. 　Yamashita S, Chujo M, Kawano Y, et al. Clinical impact of segmentectomy compared with lobectomy under complete video-assisted thoracic surgery in the treatment of stage I non-small cell lung cancer. J Surg Res, 2011, 166 （1）： 46-51.
11. 　Oizumi H, Kanauchi N, Kato H, et al. Total thoracoscopic pulmonary segmentectomy. Eur J Cardiothorac Surg, 2009, 36 （2）： 374-377.
12. 　Okada M, Nishio W, Sakamoto T, et al. Effect of tumor size on prognosis in patients with non-small cell lung cancer： the role of segmentectomy as a type of lesser resection. J Thorac Cardiovasc Surg, 2005, 129 （1）： 87-93.
13. 　Nakamura K, Saji H, Nakajima R, et al. A phase III randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer （JCOG0802/WJOG4607L）. Jpn J Clin Oncol, 2010, 40 （3）： 271-274.
14. 　National Institutes of Health. National Cancer Institute. CALGB-140503. Phase Ⅲ randomized study of lobectomy versus sublobar resection in patients with small peripheral stage IA non-small cell lung cancer. [2010-03-16] http：//www. cancer. gov/clinicaltrials/CALGB-140503.
15. 　El-Sherif A, Gooding WE, Santos R, et al. Outcomes of sublobar resection versus lobectomy for stage I non-small cell lung cancer： a 13-year analysis. Ann Thorac Surg, 2006, 82 （2）： 408-415.
16. 　Sienel W, Stremmel C, Kirschbaum A, et al. Frequency of local recurrence following segmentectomy of stage IA non-small cell lung cancer is influenced by segment localization and width of resection margins–implications for patient selection for segmentectomy. Eur J Cardiothorac Surg, 2007, 31 （3）： 522-527.
17. 　El-Sherif A, Fernando HC, Santos R, et al. Margin and local recurrence after sublobar resection of non-small cell lung cancer. Ann Surg Oncol, 2007, 14 （8）： 2400-2405.
18. 　Sawabata N, Ohta M, Matsumura A, et al. Optimal distance of malignant negative margin in excision of nonsmall cell lung cancer： a multicenter prospective study. Ann Thorac Surg, 2004, 77 （2）： 415-420.
19. 　Watanabe S, Oda M, Go T, et al. Should mediastinal nodal dissection be routinely undertaken in patients with peripheral small-sized （2 cm or less） lung cancer? Retrospective analysis of 225 patients. Eur J Cardiothorac Surg, 2001, 20 （5）： 1007-1011.
20. 　Okada M, Koike T, Higashiyama M, et al. Radical sublobar resection for small-sized non-small cell lung cancer：a multicenter study. J Thorac Cardiovasc Surg, 2006, 132 （4）：769-775.
21. 　Wolf AS, Richards WG, Jaklitsch MT, et al. Lobectomy versus sublobar resection for small （2 cm or less） non-small cell lung cancers. Ann Thorac Surg, 2011, 92 （5）： 1819-1823.
  1. 1. 　Churchill ED, Belsey R. Segmental pneumonectomy in bronchiectasis： The lingula segment of the left upper lobe. Ann Surg, 1939, 109 （4）： 481-499.
  2. 2. 　Bonfils-Roberts EA, Clagett OT. Contemporary indications for pulmonary segmental resections. J Thorac Cardiovasc Surg, 1972, 63 （3）： 433-438.
  3. 3. 　Jensik RJ, Faber LP, Milloy FJ, et al. Segmental resection for lung Cancer. a fifteen-year experience.J Thorac Cardiovasc Surg, 1973, 66（4）： 563-572.
  4. 4. 　Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung Cancer. Ann Thorac Surg, 1995, 60 （3）： 615-623.
  5. 5. 　Fernando HC, Santos RS, Benfield JR, et al. Lobar and sublobar resection with and without brachytherapy for small stage IA non-small cell lung Cancer. J Thorac Cardiovasc Surg, 2005, 129 （2）： 261-267.
  6. 6. 　Okumura M, Goto M, Ideguchi K, et al. Factors associated with outcome of segmentectomy for non-small cell lung cancer： long-term follow-up study at a single institution in Japan. Lung Cancer, 2007, 58 （2）： 231-237.
  7. 7. 　Okada M, Mimura T, Ikegaki J, et al. A novel video-assisted anatomic segmentectomy technique： selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. Thorac Cardiovasc Surg, 2007, 133 （3）： 753-758.
  8. 8. 　Watanabe A, Ohori S, Nakashima S, et al. Feasibility of video-assisted thoracoscopic surgery segmentectomy for selected peripheral lung carcinomas. Eur J Cardiothorac Surg, 2009, 35 （5）： 775-780.
  9. 9. 　Sugi K, Kobayashi S, Sudou M, et al. Long-term prognosis of video-assisted limited surgery for early lung cancer. Eur J Cardiothorac Surg, 2010, 37 （2）：456-460.
  10. 10. 　Yamashita S, Chujo M, Kawano Y, et al. Clinical impact of segmentectomy compared with lobectomy under complete video-assisted thoracic surgery in the treatment of stage I non-small cell lung cancer. J Surg Res, 2011, 166 （1）： 46-51.
  11. 11. 　Oizumi H, Kanauchi N, Kato H, et al. Total thoracoscopic pulmonary segmentectomy. Eur J Cardiothorac Surg, 2009, 36 （2）： 374-377.
  12. 12. 　Okada M, Nishio W, Sakamoto T, et al. Effect of tumor size on prognosis in patients with non-small cell lung cancer： the role of segmentectomy as a type of lesser resection. J Thorac Cardiovasc Surg, 2005, 129 （1）： 87-93.
  13. 13. 　Nakamura K, Saji H, Nakajima R, et al. A phase III randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer （JCOG0802/WJOG4607L）. Jpn J Clin Oncol, 2010, 40 （3）： 271-274.
  14. 14. 　National Institutes of Health. National Cancer Institute. CALGB-140503. Phase Ⅲ randomized study of lobectomy versus sublobar resection in patients with small peripheral stage IA non-small cell lung cancer. [2010-03-16] http：//www. cancer. gov/clinicaltrials/CALGB-140503.
  15. 15. 　El-Sherif A, Gooding WE, Santos R, et al. Outcomes of sublobar resection versus lobectomy for stage I non-small cell lung cancer： a 13-year analysis. Ann Thorac Surg, 2006, 82 （2）： 408-415.
  16. 16. 　Sienel W, Stremmel C, Kirschbaum A, et al. Frequency of local recurrence following segmentectomy of stage IA non-small cell lung cancer is influenced by segment localization and width of resection margins–implications for patient selection for segmentectomy. Eur J Cardiothorac Surg, 2007, 31 （3）： 522-527.
  17. 17. 　El-Sherif A, Fernando HC, Santos R, et al. Margin and local recurrence after sublobar resection of non-small cell lung cancer. Ann Surg Oncol, 2007, 14 （8）： 2400-2405.
  18. 18. 　Sawabata N, Ohta M, Matsumura A, et al. Optimal distance of malignant negative margin in excision of nonsmall cell lung cancer： a multicenter prospective study. Ann Thorac Surg, 2004, 77 （2）： 415-420.
  19. 19. 　Watanabe S, Oda M, Go T, et al. Should mediastinal nodal dissection be routinely undertaken in patients with peripheral small-sized （2 cm or less） lung cancer? Retrospective analysis of 225 patients. Eur J Cardiothorac Surg, 2001, 20 （5）： 1007-1011.
  20. 20. 　Okada M, Koike T, Higashiyama M, et al. Radical sublobar resection for small-sized non-small cell lung cancer：a multicenter study. J Thorac Cardiovasc Surg, 2006, 132 （4）：769-775.
  21. 21. 　Wolf AS, Richards WG, Jaklitsch MT, et al. Lobectomy versus sublobar resection for small （2 cm or less） non-small cell lung cancers. Ann Thorac Surg, 2011, 92 （5）： 1819-1823.