Video-Assisted Thoracoscopic Lobectomy for Localized RML Bronchiectasis

對局限在右中肺葉支氣管擴張症之胸腔鏡肺葉切除手術

賴重佑(Chung-Yu Lai) ； 林同森(Torng-Sen Lin) ； 鄭清源(Ching-Yuan Cheng) ； 陳恆中(Heng-Chung Cheng) ； 陳宗銘(Tsong-Ming Cheng) ； 吳金燕(Chin-Yen Wu) ； 張靖苓(Ching-Ling Chang) ； 吳美雯(Mei-Wen Wu) ； 方信元(Hsin-Yuan Fang)

《胸腔醫學》 18卷1期 (2003/02) Pp. 9-14

摘要

引言：支氣管擴張症的治療方式在這半世紀以來已經被廣泛地討論。一般已經被接受的是支氣管擴張的病程變化為不可逆性；因此，僅有把病變的肺節切除才有治癒的可能。我們回顧過去對局限在右中肺葉的支氣管擴張症之影像輔助胸腔鏡肺葉切除術的十三位病人經驗來評估以手術方式治療的結果。
病患及方法：從1995年三月到2001年九月，我們共收集了十三位患有右中肺葉支氣管擴張的病人使用影像輔助胸腔鏡肺葉切除術。手術的適應症為：內科治療方式失敗的有十位（77%），重複肺部感染的有三位（23%），嗑血的有四位（31%），合併重複肺部感染和嗑血的有六位（46%）。針對這些良性的肺部疾病，我們使用影像輔助胸腔鏡手術外加一個四公分的迷你開胸術來完成右中肺葉的肺葉切除。
結果：在這十三例手術當中，我們發生了兩例併發症，包括一位肺炎及另一位術後血胸，但是不需要再次手術處理。術後的平均住院天數為六天。十三位病人的平均追蹤期間為四十五個月。在這全部十三位病人裡總共有十位病人完全治愈，三位病人症狀改善，全都皆因接受手術而獲得助益。沒有手術死亡病例。
結論：支氣管擴張症的手術治療方式提供了較低的死亡率和併發症，並且可以產生立即的症狀解除和改善生活品質。而對這些良性的肺部疾病，影像輔助胸腔鏡手術確實不失為一合理又安全的治療方式。

關鍵字

支氣管擴張症 ； 影像輔助胸腔鏡手術 ； 影像輔助胸腔鏡肺葉切除手術

並列摘要

Background: The management of bronchiectasis has been discussed widely for decades. It is generally agreed that the bronchiectasis process is irreversible, and only resection of the involved bronchiectatic segments offers the possibility of potential cure. We present herein our experience with video-assisted thoracoscopic lobectomy for localized right middle lobe bronchiectasis in 13 patients.
Patients and Methods: From March 1995 to September 2001, we enrolled 13 patients with right middle lobe bronchiectasis. There were 8 females and 5 males, with a mean age of 37 years old (ranging from 21 to 53 years). The mean duration of symptoms, such as hemoptysis and chronic purulent productive cough, was 4.3 years (ranging from 2 to 7 years). Surgical indications included repeat pulmonary infection in 3 patients (23%), massive hemoptysis in 4 patients (31%), and both repeat pulmonary infection and hemoptysis in 6 patients (46%). During the operation, all patients were placed in the left lateral position, under double lumen intubated anesthesia. Three incisions were needed：a 1-cm incision for the camera port was created at the 7th intercostal space along the anterior axillary line, and two other 1-cm and 4-cm incisions were made at the 7th and 5th intercostal space along the mid-clavicular line. The right middle lobectomy could be completed using either traditional or endoscopic instruments.
Results: The mean total operative time was 87 minutes (ranging from 60 to 110 minutes). The mean hospital stay was 6 days (ranging from 5 to 11 days). Complications occurred in 2 patients, and included one pneumonia and one postoperative mild hemothorax. There was no surgical mortality in this study. The mean follow-up period was 45 months (ranging from 5 to 83 months). Overall, 10 patients were asymptomatic, and the other three showed apparent symptomatic improvement after operation.
Conclusions: Video-assisted thoracoscopic lobectomy for right middle lobe bronchiecatsis is a feasible and safe procedure for treating patients with localized right middle lobe bronchiectasis.

並列關鍵字

bronchiectasis ； video-assisted thoracoscopic surgery ； video-assisted thoracoscopic lobectomy