电视胸腔镜下纵隔肿瘤手术54例报告  

Video-assisted Thoracoscopic Surgery for Mediastinal Neoplasms: Report of 54 Cases

作　　者：柳常青[1] 徐美清[1] 郭明发[1] 解明然[1] 江贤亮[1] 孙效辉[1] 孙翔翔[1] 

机构地区：[1]安徽省立医院胸外科,合肥230001

出　　处：《中国微创外科杂志》2013年第8期683-684,688,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)治疗纵隔肿瘤的安全性及有效性。方法回顾性分析我院2009年1月～2011年9月行胸腔镜下纵隔肿瘤手术54例。一般置3个trocar,首先于腋中线第6～8肋间置第1个trocar(1.0 cm),置入30°10 mm硬质胸腔镜探查,明确病变部位及其毗邻关系后,按照倒三角形决定另外2个trocar(1.5～2.0 cm)的部位,术中根据情况可将操作孔与镜孔互换。若肿瘤较大,或与周围粘连不易显露,或与大血管关系紧密,考虑出血后不易止血采用胸腔镜辅助小切口(video-assisted minithoracotomy,VAMT),沿trocar延长小切口5～8 cm直视下操作。结果 41例全胸腔镜下完成手术;12例胸腔镜辅助小切口;1例因肿瘤侵犯左无名静脉中转开胸手术。1例胸腺增生伴重症肌无力,术中损伤膈神经,术后胸片提示患侧膈肌抬高,术后6个月复查胸片恢复。2例术后气胸,经胸腔闭式引流后痊愈;均未出现术中及术后近期(30 d内)死亡。术后病理:胸腺瘤18例,胸腺增生12例,胸腺癌1例,支气管囊肿8例,胸腺囊肿1例,淋巴细胞增生2例,畸胎瘤4例,神经源性肿瘤6例,胸膜脂肪瘤1例,胸腺孤立性纤维瘤1例。54例随访8～36个月,中位随访时间23个月,所有良性肿瘤均无复发,侵袭性胸腺瘤复发1例。结论电视胸腔镜纵隔肿瘤切除是可行和安全的,可获得满意的临床效果。Objective To evaluate the efficacy and safety of video-assisted thoracoscopic surgery （VATS） in the treatment of mediastinal neoplasms. Methods Fifty-four patitents with mediastinal neoplasms underwent VATS from January 2009 to September 2011. Generally three trocars were inserted. The first trocar （ 1. 0 cm） was placed at the sixth to eighth intercostal space in the midaxillary line. A 30-degree thoracoscope was inserted through this port for exploration. After confirming the location of lesion, we placed other two trocars （ 1. 5 - 2.0 cm） according to the inverted triangle. The operating and camera trocars were exchanged if it was needed. Video-assisted minithoracotomy （VAMT） was applied for those cases such as bigger tumors, difficult exposure due to adjacent adhesions and adjacence to major vessels. Results The procedures were successfully completed in 41 patients. Twelve patients were performed by video-assisted minithoracotomy（ VAMT）, and one patient was converted to open surgery because of suspected involvement of the left anonymous vein. Phrenic nerve injury occurred in one patient with thymus hyperplasia combined with myasthenia gravis during operation, whose postoperative X-ray suggested lateral diaphragm elevation, and he recovered 6 months after operation. Two patients suffered from pneumothorax after operation and were cured by thoracic closed drainage. No intraoperative or early postoperative death （ within 30 d after operation） was found. Postoperative pathological examination showed that thymoma in 18 cases, thymic hyperplasia in 12 cases, thymic cancer in 1 case, bronchocele in 8 cases, thymic cyst in 1 case, lymphocyte proliferation in 2 cases, teratoma In 4 cases, neurogenic tumor in 6 cases, pleural lipoma in 1 case, solitary thymus gland fibroma in 1 case. Fifty-four patients were followed up for 8 to 36 months （ mean,23 months）, during which no one had recurrence or metastasis except one patient with thymic carcinoma. Conclusion Resection of mediastinal neoplasms

关 键 词：电视胸腔镜手术 纵隔肿瘤 

分 类 号：R734.5[医药卫生—肿瘤]