Objective To analyze the clinical efficiency of conversion to thoracotomy in complete thoraco‐scopic lobectomy and to investigate the reasons which caused the conversion to thoracotomy .Methods One hun‐dred and eighty‐three patients ,who came to our hospital for treatment of lobectomy thoracic surgery including 19 cases of conversion to thoracotomy in January 2011 to June 2014 ,were divided into VATS group and conversion to thoracotomy group according to whether the patients were transmitted thoracotomy .We compared the age ,sur‐gery time ,blood loss ,drainage tube time ,drainage ,hospital stay and complications and so on ,and analyzed the underlying reasons causing conversion to thoracotomy .Results Compared with the VATS group ,operative time [(245 ± 47)mL vs (143 ± 67)mL] ,blood loss [(355 ± 27)mL vs (232 ± 15)mL] ,drainage tube time [(10 ± 6)d vs (7 ± 4)d] ,drainage [(1 426 ± 67)mL vs (873 ± 78)mL] ,length of hospital stay [(13 ± 5)d vs (9 ± 4)d] of conver‐sion to thoracotomy group were significantly increased ,which were significantly different( P<0.05) .The causes of conversion to thoracotomy group included vascular injury (32% ) ,the dense connections (26% ) ,lymph node interference (21% ) and other factors (21% ) .The incidence of vascular was higher than that of other groups ,the difference was significant ( P <0.05) .Pulmonary injury (57% ) was the major damage ,incidence of this injury was significantly higher than other injuries ,the difference was significant( P<0 .05) .Conclusion Compared with VATS group ,conversion to thoracotomy was more complex and of greater injury .Clinicians should avoid this . Vascular injury was the best reason which caused conversion to thoracotomy .We should try our best to avoid vas‐cular injury and reduce the negative impact on patients.%目的：分析全胸腔镜肺叶切除（VATS）中转开胸的临床疗效，同时探讨引起VATS中转开胸的原因。方法分析2011年1月至2014年6月于我院胸外科行VATS的183例患者的临床资料，根据术中是否行中转开胸将患者分成单纯VATS组（n＝164）和中转开胸组（n＝19），分别比较2组患者的手术时间、术中出血量、引流管放置时间、引流量、住院时间以及并发症等观察指标，并统计分析引起中转开胸的相关原因。结果中转开胸组与单纯VATS组相比，手术时间[（245±47）min与（143±67）min]、术中出血量[（355±27）mL与（232±15）mL]、引流管放置时间[（10±6）d与（7±4）d]、引流量[（1426±67）mL与（873±78）]mL）、住院时间[（13±5）d与（9±4）d）]均差异具有统计学意义（P＜0.05）。引起中转开胸的原因包括血管损伤（32％），致密粘连（26％），淋巴结干扰（21％）、其他因素（21％），其中由血管损伤引起的中转开胸的平均手术时间[（285±37）min）]和术中出血量[（455±27）mL]比由其他原因引起的中转开胸的平均手术时间和术中出血量升高，差异具有统计学意义（P＜0.05）；肺动脉损伤（57％）是最主要的血管损伤，损伤发生率较其他损伤升高，差异具有统计学意义（P＜0.05）。结论VATS中转开胸较单纯VATS手术复杂且对患者伤害更大，临床应尽量避免。血管损伤是引起中转开胸的最主要因素，临床在行VATS过程中应尽量注意避免损伤血管，以减轻患者所受的负面影响。
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