电视胸腔镜手术在纵隔肿瘤切除中的应用  

Video-assisted Thoracoscopic Surgery for Mediastinal Tumor Resection

作　　者：曹强[1] 王启[1] 许瑞彬[1] 

机构地区：[1]延安大学附属医院胸心外科,延安716000

出　　处：《中国微创外科杂志》2013年第9期814-816,823,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨电视胸腔镜手术在纵隔肿瘤切除中的临床应用价值。方法回顾性比较我院2007年11月～2011年8月20例电视胸腔镜手术（video—assistedthoracoscopicsurgery，VATS）和20例标准开胸手术（标准开胸组）行纵隔肿瘤切除的开胸时间、开胸出血量、实际手术时间、关胸时间、总手术时间、术后引流量、带管时间、术后住院时间、术后肩关节活动障碍、术后肺部并发症以及术后随访。结果VATS组1例胸腔粘连较重，行胸腔镜辅助小切口手术（video—assistedminithoracomoty，VAMT）。与开胸组相比，VATS组开胸时间短[（12．1±2．0）rainVS．（18．1±2．4）rain，t=-8．589，P=0．000]，关胸时间短[（11．4±1．7）min vs．（21．4±2．7）min，t=-14．017，P=0．000]，开胸出血量少[（13．2±4．3）mlVS．（25．2±11．4）ml，t=-4．405，P=0．000]，术后引流量少[（355．6±110．8）ml VS．（655．6±135．8）ml，t=-7．655，P=0．000]，带管时间短[（3．2±0．5）dVS．（4．5±1．1）d，t=-4．812，P=0．000]。2组术后肩关节功能障碍发生率无统计学差异[5％（1／20）VS．25％（5／20），P=0．182]。40例随访8～12个月，均无肿瘤复发。结论VATS对大多数纵隔良性肿瘤，特别是大部分囊性病变及后纵隔神经源性肿瘤的切除较开胸手术具有明显优势。Objective To explore the clinical value of video-assisted thoracoscopic surgery in the treatment of mediastinal tumor. Methods Between November 2007 and August 2011 ,the clinical data of 20 cases undergoing video-assisted thoracoscopic surgery （VATS group） and 20 cases undergoing standard posterolatera] thoracotomy （open group） were retrospectively analyzed. The chest opening time, intraoperative blood loss, actual operation time, chest closing time, total operation time, postoperative drainage volume, postoperative intubation time, postoperative hospital stay, postoperative pulmonary complications, and postoperative joint dysfunction were compared between the two groups. Results One case in VATS group received video-assisted minithoracomoty because of severe pleural adhesion. Compared with open group, the chest opening and closing time of the VATS group were statistically shorter [（12.1±2.0）minvs. （18.1 ±2.4）min,t= -8.589,P=0.000; （11.4±1.7）miu vs. （21.4 ±2.7）min, t ： -14.017, P = 0. 000 ] ; the intraoperative blood loss and drainage volume of the VATS group were less [ （ 13.2 ± 4.3 ） ml vs. （25.2 ± 11.4） ml, t= -4.405,P=0.000; （355.6±110.8）mlvs. （655.6±135.8）ml, t= -7.655, P=0. 000]; intubation time of the VATS was shorter [ （3.2 ±0. 5）d vs. （4.5 ±1.1 ）d, t = -4. 812, P = 0. 000 ]. There was no distinct difference in the rate of postoperative joint dysfunction between the two groups [5% （1/20） vs. 25% （5/20） , P =0. 1821. Forty patients were followed up for 8 to 12 months, and no recurrence was found. Conclusion Video-assisted thoracoscopic surgery has distinct advantages over thoracotomy in the management of most mediastinal benign tumors, especially for most cystic lesions and posterior mediastinum neurogenic tumors.

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]