胸腔镜胸腺扩大切除术  

Maximal thymectomy by VATS

作　　者：何建行[1] 杨运有[1] 张镜方[2] 曾仑 陈满荫[1] 韦兵[1] 殷伟强[1] 

机构地区：[1]广东省广州呼吸疾病研究所,510120 [2]广东省心血管病研究所,510080

出　　处：《广东医学》2000年第4期270-272,共3页Guangdong Medical Journal

基　　金：广东省科委重点攻关课题基金资助!(基金编号:303005015)

摘　　要：目的探讨胸腔镜胸腺扩大切除术的手术方法和适应证。方法利用胸腔镜进行胸腺扩大切除术共２２例。病种包括重症肌无力 １７例，其中Ⅰ型 ２例，Ⅱａ型 ４例，Ⅱｂ型 ６例，Ⅳ型 ５例，伴胸腺瘤 ９例；单纯胸腺瘤 ５例。切除范围从全胸腺组织到前纵隔和上纵隔的所有脂肪样软组织。瘤体在　ｃｍ以下胸腺瘤胸腺扩大切除术可以在内镜下完成。结果手术时间１～３ｈ，平均１．５ｈ，术中出血量＜１００ｍｌ，术后住院时间３～１５ｄ，平均６．５ｄ。重症肌无力组有效率８８％。单纯胸腺瘤组未见肿瘤复发。结论胸腔镜用于瘤体在 ２ ｃｍ以下胸腺瘤胸腺扩大切除术，手术方法可行、可靠，较好地保持了胸廓完整性和减少术后切口疼痛。对瘤体在４ ｃｍ以上胸腺瘤，胸腺扩大切除术最好结合微创伤小切口进行。Objective To research the indication and operative method of thorascopic maximal thymectomy. Method From June 1995 to December 1998, 22 cases of the maximal thymectomy had been done by VATS, including 17 cases of myasthenia gravis, 9 cases with thymoma, 2 in stage Ⅰ, 4 in stage Ⅱ a, 6 in stage Ⅱ b, 5 in Ⅳ; 5 cases thymoma not with myasthenia gravis. Resected area from thymus and all lipoid tissue in the front mediastinum. Results The front mediastinum and thymus could be showed clearly by video, the operative time from 1 to 3 hours, mean l.5 hours; mean bleeding loss was less l00 ml; recovered time from 3 to 15 days, mean 6.5 days; effective rate was 88%, no thymoma recurred. Conclusion The maximal thymectomy can be resected completely by VATS in myasthenia gravis and thymoma less 2 cm, if the thymoma is larger than 4 cm, minithoracectomy should be better.

关 键 词：胸腺扩大切除术 胸腔镜 术式 适应证 

分 类 号：R655.05[医药卫生—外科学]