胸腔镜手术在肺多发结节中应用及其预后

发布时间：2018-03-25 09:11

本文选题：胸腔镜　切入点：肺多发结节　出处：《福建医科大学》2014年硕士论文

【摘要】：目的：探讨胸腔镜在肺部多发结节诊治中的应用、手术方式的选择及其预后。方法：回顾性分析福建医科大学附属协和医院胸外科2011年2月至2014年2月115例行胸腔镜手术的肺部多发结节患者临床资料。其中男性51例，女性64例，年龄18-83岁，平均（56±11）岁，综合分析患者多发结节部位、手术方式、术后病理、术后并发症及术后随访情况等。结果：所有患者均完成胸腔镜手术，其中同侧多发结节51例，双侧多发结节64例，结节数2-6个不等；结节直径0.3-3cm。全胸腔镜114例，辅助小切口1例，无中转开胸，无围手术期死亡。行胸腔镜肺楔形切除65例，肺段切除10例，，肺叶切除38例，肺段+肺叶切除2例，无全肺切除手术病例。术后组织病理学提示恶性73例，其中原发性肺癌57例，转移瘤16例；良性42例。手术平均176±78min，术中出血量平均102ml(10-700ml)，术后胸管留置时间平均3.77±2.23天，术后严重并发症发生率1.74%（2/115），术后住院平均时间6.55±3.18天。随访2月-3年总体生存率96.04%（97/101），其中肺癌生存率91.2%。结论：1.胸腔镜手术在肺多发结节诊治中具有重要作用，是一种切实可靠、安全、有效的诊疗措施。2.肺多发结节以肺癌、转移瘤、肺结核、真菌感染、纤维化结节、炎性假瘤、肺内淋巴结等常见。3.肺多发结节总体近期生存率高、生存质量较好、复发转移较低，应积极处理。
[Abstract]:Objective: to explore the application of thoracoscopy in the diagnosis and treatment of multiple pulmonary nodules, the choice of surgical methods and prognosis. Methods: the clinical data of 115 patients with multiple pulmonary nodules underwent thoracoscopic surgery from February 2011 to February 2014 were retrospectively analyzed, including 51 males and 64 females, aged 18-83 years, with an average age of 56 卤11 years. The location of multiple nodules, surgical methods, postoperative pathology, postoperative complications and postoperative follow-up were comprehensively analyzed. Results: all the patients underwent thoracoscopic surgery, including 51 cases of ipsilateral multiple nodules, 64 cases of bilateral multiple nodules, ranging in number from 2 to 6, the diameter of nodules ranged from 0.3 to 3 cm. Total thoracoscopy was performed in 114 cases, assisted small incision in 1 case, with no conversion to thoracotomy. No perioperative death. Thoracoscopic wedge resection was performed in 65 cases, segmental resection in 10 cases, lobectomy in 38 cases, lobectomy in 2 cases, and no total pneumonectomy. There were 57 cases of primary lung cancer, 16 cases of metastatic tumor, 42 cases of benign tumor. The average operation time was 176 卤78 min, the average intraoperative bleeding was 102ml 10 ~ 700ml / L, the mean time of thoracic tube indwelling was 3.77 卤2.23 days. The average postoperative hospitalization time was 6.55 卤3.18 days. The overall survival rate was 96.04% / 101%, and the survival rate of lung cancer was 91.2%. Conclusion 1. Thoracoscopic surgery plays an important role in the diagnosis and treatment of multiple pulmonary nodules. It is a reliable, safe and effective diagnostic and therapeutic measure. 2. Lung cancer, metastatic tumor, pulmonary tuberculosis, fungal infection, fibrosis nodules, inflammatory pseudotumor. Pulmonary multiple nodules have high short-term survival rate, better quality of life, lower recurrence and metastasis, and should be actively dealt with.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R655

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