Video-Assisted Thoracic Surgery Lobectomy: Experience with 36 Cases

비디오 흉강경을 이용한 폐엽절제술: 치험 36예

  • Lee, Hee-Sung (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University) ;
  • Lee, Jae-Woong (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University) ;
  • Kim, Kun-Il (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University) ;
  • Cho, Sung-Woo (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University) ;
  • Park, Sang-Jun (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University) ;
  • Kim, Hyoung-Soo (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University) ;
  • Shin, Yoon-Cheol (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University) ;
  • Shin, Ho-Seung (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University)
  • 이희성 (한림대학교 의과대학 흉부외과학교실) ;
  • 이재웅 (한림대학교 의과대학 흉부외과학교실) ;
  • 김건일 (한림대학교 의과대학 흉부외과학교실) ;
  • 조성우 (한림대학교 의과대학 흉부외과학교실) ;
  • 박상준 (한림대학교 의과대학 흉부외과학교실) ;
  • 김형수 (한림대학교 의과대학 흉부외과학교실) ;
  • 신윤철 (한림대학교 의과대학 흉부외과학교실) ;
  • 신호승 (한림대학교 의과대학 흉부외과학교실)
  • Published : 2009.12.05

Abstract

Background: Many video-assisted thoracic surgery (VATS) lobectomies are performed as a potential alternative to thoracotomy despite the controversy about the safety and the associated morbidity/mortality rates. Material and Method: Between November 2006 and August 2008, we performed 87 lobectomies (VATS 36, Thoracotomy 51) and we retrospectively reviewed the surgical treatment results. A VATS lobectomy was performed by a 4~5 cm thoracotomy without rib spreading and this included anatomic hilar dissection, individual vessel and bronchus stapling and lymph node dissection. Result: We studied 52 male and 35 female patients whose age ranged from 6 to 79 (average age: $59.8{\pm}15.0$ years). The cases were diagnosed with lung cancer (66) (SQC 24, ADC 38, others 4), pulmonary metastasis (2), carcinoid (2) and benign diseases (17). There was no intraoperative death. Postoperative complications were seen in 5 (15.6%) VATS and 33 (64.7%) thoracotomies, and perioperative death caused by adult respiratory distress syndrome occurred in 1 (2.8%) VATS and 3 (5.9%) thoracotomies. Three patients Underwent conversion to thoracotomy (8.3%). The mean time to chest tube removal was 6 days for VATS and 9.4 days for thoracotomy (p<0.001), and the mean length of the hospital stay was 8 days for VATS and 12.8 days for thoracotomy (p<0.001). Conclusion: VATS lobectomy can be performed safely with low morbidity/mortality rates. Furthermore, all the patients benefited from earlier postoperative rehabilitation and less pain and they were candidates for an earlier return to normal activities.

배경: 비디오 흉강경을 이용한 폐엽절제술은 최근 흉곽절개술을 대체하며 많이 시행하고 있다. 그러나 이러한 수술법의 안전성과 이환율 및 사망률에 대해서는 논쟁이 있다. 대상 및 방법: 2006년 11월부터 2008년 8월까지 폐엽절제술을 시행한 87명의 환자(비디오 흉강경 36명, 흉곽절개술 51명)를 대상으로 수술적 치료결과를 후향적으로 조사하였다. 비디오 흉강경을 이용한 폐엽절제술은 4~5 cm 정도의 흉부절개창을 늑간을 벌리지 않고 각각의 폐문부 혈관 및 기관지의 박리와 임파선 생검과 박리를 시행하였다. 결과: 대상 환자들의 연령은 6세에서 79세까지였고 평균 연령은 $59.8{\pm}15.0$세였다. 남자가 52명, 여자가 35명이었다. 환자들의 조직학적 검사 결과는 원발성 폐암 66예(편평상피세포암 24예, 선암 38예, 그 외 4예), 전이암 2예, 폐 유암종 2예, 양성 폐 질환 17예였다. 수술 중 사망은 없었으며 수술 후 합병증은 각각 비디오 흉강경 5명(15.6%), 흉곽절개술 33명(64.7%)에서 발생하였다. 수술 후 사망은 비디오 흉강경 1명(2.8%), 흉곽절개술 3명(5.9%)의 환자가 수술 후 급성 호흡곤란 증후군으로 사망하였다. 비디오 흉강경을 이용한 폐엽절제술 중 3명(8.3%)의 환자가 흉곽절개술로 전환되었다. 흉관은 수술 후 각각 비디오 흉강경 6일, 흉곽절개술 9.4일째 제거되었으며(p<0.001), 퇴원은 수술 후 각각 비디오흉강경 8일, 흉곽절개술 12.8일째 시행되었다(p<0.001). 결론: 비디오 흉강경을 이용한 폐엽절제술은 적은 이환율과 사망률을 보였으며 안전하게 시행할 수 있다. 뿐만 아니라 수술 후 빠른 회복과 적은 통증으로 빠른 일상 생활의 복귀가 가능하였다.

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