肺癌之微創手術

肺癌近年來已經成為國人癌症死亡原因的第一名。肺癌可分為小細胞肺癌及非小細胞肺癌。早期的非小細胞肺癌可以外科手術治療，不僅可有長期存活，甚至有完全治癒的機會。近年來隨著內視鏡器材、手術技術的進步及麻醉方式的改變，微創手術已成為非小細胞肺癌手術的主流。在本論文中，我們將分三個層面來探討最近幾年肺癌微創手術的進展。第一、利用胸腔鏡肺葉切除術來治療肺癌，比傳統開胸手術傷口小、恢復快，肺功能影響較小，目前已成為治療初期非小細胞肺癌的替代治療。第二、成年人的肺臟切除後就不再重生。因此對於腫瘤小於兩公分、或心肺功能不良之病患，可進行次肺葉切除術、以減少肺臟切除範圍。文獻顯示若能仔細篩選病患，則長期存活與肺葉切除術類似。第三、利用微創之麻醉方式，如免插氣管內管的胸腔鏡手術，可以安全的進行肺葉切除手術，並減少氣管插管及使用呼吸器造成氣道及肺臟的傷害。總而言之，微創肺癌手術發展的趨勢，應該是結合傷口微創、切除微創、以及麻醉微創的高科技、高品質手術，使病患恢復得更快、更好、更有體力接受後續的化學治療、放射線治療、或標靶治療。

關鍵字

微創手術；肺癌；胸腔鏡手術

並列摘要

Lung cancer is the leading cause of cancer death in Taiwan. Surgery provides the best chance for cure and long-term survival in early stage non-small cell lung cancer (NSCLC) patients. With the advent of minimally invasive surgical techniques and instruments, thoracoscopic surgery has emerged as a reasonable alternative for the diagnosis and treatment of NSCLC. The current review focuses on three perspectives of minimal invasive surgery for lung cancer. First, thoracoscopic lobectomy has increasingly gained acceptance and it is supported by evidence- based treatment guidelines as an alternative to open thoracotomy for managing early stage lung cancer. Second, sublobar resection has become an acceptable alternative to lobectomy in patients with a tumor size less than 2 cm or with poor cardiopulmonary reserve. Sublobar resection is associated with a lower complication rate and comparable long-term survival in select patients. Third, non-intubated thoracoscopic surgery under less invasive anesthetic approaches such as thoracic epidural anesthesia and proper sedation are feasible and safe, and are associated with less intubation- and ventilator-associated complications. In summary, a combination of minimally invasive technique, parenchyma-sparing pulmonary resection, and optimal anesthesia will make lung cancer surgery safer and allow more patients to become eligible for adjuvant chemotherapy, radiotherapy, or targeted therapy whenever indicated.

並列關鍵字

thoracic surgery ； thoracoscopy ； lung cancer

國際替代計量

肺癌之微創手術

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