The Application Of Minimally Invasive Surgery In Ⅲ Period Lung Cancer Radical

Objective:The purpose of this paper is to explore the applied values of VAMT thoracic surgeons in the treatment of stage III bronchogenic carcinoma.Methods:According to the time sequence into hospital,32cases with bronchogenic carcinoma in the stage III were divided into two groups of16each:traditional thoracotomy group and MITS group. In MITS group:12cases of male,4cases of female, age from48to78years old, an average age is65.8years old;9cases of Squamous cell carcinoma,3cases of gland cancer,2cases of large cell carcinoma,2cases of bronchioloalveolar carcinoma cells. According to1997UICC standards,7cases with bronchogenic carcinoma in stage Ⅲa,9cases in stage Ⅲb. Operation method:3cases of upper left lobectomy (1case of sleeve resection),2cases of lower left lobectomy,3cases of left pneumonectomy,3cases of upper right lobectomy (2cases of sleeve resection),2cases of lower right lobectomy,2cases of lower right lobectomy.1cases of right pneumonectomy.1cases of the trachea right lung convex resection.1cases of the trachea left lung convex resection.1cases of the superior vena cava wall resection.1cases of left atrium resection.2cases of pulmonary artery forming. The hilar and mediastinum lymph node dissections were performed in all cases,2cases of the other side lymph node dissection, with268pieces of lymph node (every case12～23pieces, an average is16.8pieces), and Lymph nodes of metastatic cancer with pathological diagnosis are95pieces. In traditional thoracotomy group:10cases of male,6cases of female, age from43to70years old, an average age is62.6years old;7cases of Squamous cell carcinoma,4cases of gland cancer,1cases of large cell carcinoma,3cases of bronchioloalveolar carcinoma cells,1cases of mixed carcinoma. According to1997UICC standards,8cases with bronchogenic carcinoma in stage Ⅲa,8cases in stage Ⅲb. Operation method:2cases of upper left lobectomy,1cases of left lower lobe resection, and3cases of left pneumonectomy,5cases of upper right lobectomy (including3cases of sleeve resection),1cases of lower right lobectomy,3cases of right below the lobectomy,2cases of right pneumonectomy.2cases of Chest wall and part of the ribs resection.1cases of Local resection of the diaphragm. The superior vena cava replacement/vascular bypass surgery in2cases. Left atrium resection in2cases. All the tracheal long convex resection in1case. Pulmonary artery forming in3cases. The hilar and mediastinum lymph node dissections were performed in all cases,3cases of the other side lymph node dissection, with257pieces of lymph node (every case11～24pieces, an average is16.1pieces), and Lymph nodes of metastatic cancer with pathological diagnosis are91pieces.Results:All of the cases are successful, MITS group without extend incision, two groups were no death during perioperative period. The operation time of MITS group is significantly longer than traditional thoracotomy group (P<0.05); Intraoperatie bleeding and Postoperative Pleural effusion amount in MITS group is significantly less than traditional thoracotomy group (P<0.05); The postoperative respiratory complications in MITS group is less than traditional thoracotomy group, but no statistical difference (P>0.05), arrhythmia incidence between two groups is no difference (P>0.05), The other complications including anastomotic fistula and breast milk between two groups did not happenned; The chest incision liquefied incidence in MITS group is less than traditional thoracotomy group, but the difference was not statistically significant (P>0.05); The postoperative pain in MITS group is significant light than the traditional thoracotomy group,(P<0.05); The postoperative hospitalization days of traditional thoracotomy group is significantly longer than MITS group (P<0.05). Total number and local number of lymph node dissection、regional lymph node metastasis rate and metastasis degrees between the two group is no statistically significant difference (P>0.05).Conclution:As long as the operation indication、operation methods and skills is reasonably used, operation in the stage III bronchogenic carcinoma by Video-assisted mini-thoracotomy is a safe and effective procedure in thoracic surgery with less mortality and morbidity.