探讨电视胸腔镜手术(VATS)下解剖性肺段切除术的可行性及安全性。

回顾性分析2012年1月至2014年12月南阳医学专科学校第一附属医院对36例肺部病变患者行VATS下解剖性肺段切除术的临床资料。其中行左肺上叶尖前后段切除(固有段)5例和舌段切除7例，左肺下叶背段切除4例和基底段切除4例；右肺上叶尖段切除3例、前段切除2例和后段切除3例，右肺下叶背段切除5例和基底段切除3例。

该组患者均顺利完成肺段切除术，术中无中转开胸。手术时间105～310 min，平均175 min；术中出血30～210 ml，平均125 ml；术后胸腔闭式引流量160～1 250 ml，平均350 ml；术后引流管置管时间2～9 d，平均4 d；术后住院时间4～15 d，平均7 d。术后1周内出现胸腔出血1例，房颤1例，持续性肺漏气1例，肺部感染2例，经治疗后好转出院，术后并发症发生率13.8%(5/36)。术后随访时间1～32月，平均12月。术后2个月复查胸部CT,切除肺段的邻近肺段均膨胀良好，17例原发性肺癌(除外4例转移癌)均无复发和转移。

VATS下解剖性肺段切除术安全、可行，实现了最精准、微创的病变部位切除。

To evaluate the feasibility and safety of anatomic segmentectomy with video-assisted thoracoscopic surgery(VATS).

The clinical data of 36 patients with lung diseases undergoing anatomic segmentectomy with VATS in the First Affiliated Hospital of Nanyang Medical College between January 2012 and December 2014 were retrospectively analyzed. Left lung apex posterior segmental resection(natural section) was done in 5 cases, and tongue resection in 7 cases; left lung lobe resection in 4 cases, and basal segment resection in 4 cases; right lung apex segmental resection in 3 cases, anterior resection in 2 cases, and posterior resection in 3 cases; right lung dorsal segment of lower lobe resection in 5 cases, and basal segment resection in 3 cases.

All patients completed anatomic segmentectomy, and there was no transfer to open chest surgery. The operation time ranged from 105 to 310 min, with an average of 175 min. The volume of bleeding was 30 to 210 ml, wih an average of 125 ml. The drainage volume was 160 to 1 250 ml, with an average of 350 ml. The time of drainage tube was 2 to 9 d, with an average of 4 d. The length of hospital stay was 4 to 15 d, with an average of 7 d. There was one case of thoracic cavity bleeding, one case of atrial fibrillation, one case of persistent pulmonary leak and two cases of pulmonary infection in one week after operation, and all were properly treated and discharged. The incidence of postoperative complications was 13.8% (5/36). The follow-up time ranged from 1 to 32 months, with an average of 12 months. Chest CT was reviewed 2 months after operation, and the adjacent lung segments to the resected expanded well. There was no recurrence or metastasis in 17 patients with primary lung cancer (excluding 4 cases of metastastic cancer).

Anatomic segmentectomy with VATS is safe and feasible, and can achieve a most precise and minimally invasive lesion resection.