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电视辅助胸腔镜肺段切除术的发展历程
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Abstract:
电视辅助胸腔镜手术(VATS)已逐渐应用于胸外科，现在已经扩展到技术上具有挑战性的手术中，如肺节段切除术及复杂肺段切除术。VATS肺段切除术的定义随着时间的推移而改变，随着低剂量肺部CT (LDCT)筛查的普及，胸腔镜下肺段切除的范围越来越广。VATS肺段切除术具有外科、肿瘤学和技术优势；然而，仍有一些领域，特别是在肿瘤学结果方面存在问题。VATS肺段切除术的适应症多种多样，可适用于临床治疗肺部恶性肿瘤、转移性肺癌或各种病灶较深的非恶性疾病。对于保留肺实质切除深部小结节或同一肺叶多处结节的手术治疗尤其具有重要意义。VATS肺段切除术需要对肺实质解剖结构进行彻底分析，并在手术评估的基础上进行量身定制的术前计划以保证术后患者的快速康复。其中的技术挑战包括术中导航、识别和解剖节段间平面的方法，以及防止术后支气管胸膜瘘等并发症。这篇综述将讨论VATS肺段切除术的现状，重点研究当前适应症和技术以及未来展望。
Video-assisted thoracoscopic surgery (VATS) has gradually been applied to thoracic surgery, and has now expanded to technically challenging operations, such as segmental resection of the lung and complex segmental resection of the lung. The definition of VATS pulmonary segment resection changes over time. With the popularization of low-dose lung CT (LDCT) screening, the scope of tho-racoscopic pulmonary segment resection is becoming wider and wider. VATS segmental pneumo-nectomy has advantages in surgery, oncology and technology. However, there are still problems in some areas, especially in oncology results. VATS pulmonary segmental resection has various indica-tions and can be used for clinical treatment of lung cancer, metastatic lung cancer or various non-malignant diseases with deep focus. It is particularly important for the surgical treatment of reserving lung parenchyma and resecting deep small nodules or multiple nodules in the same lung lobe. VATS segmental resection requires a thorough analysis of the anatomical structure of the lung parenchyma and a customized preoperative plan based on the surgical evaluation to ensure the rapid recovery of patients after surgery. The technical challenges include the methods of intraoper-ative navigation, identification and dissection of the inter-segmental plane, and the prevention of postoperative complications such as bronchopleural fistula. This review will discuss the current situation of VATS segmental pneumonectomy, focusing on the current indications, technologies and future prospects.
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