经左胸胸腔镜胸腺切除术58例分析  

Left thoracic approach for thoracoscopic thymectomy for 58 patients

作　　者：林宗武[1] 蒋伟[1] 王群[1] 徐松涛[1] 葛棣[1] 谭黎杰[1] 范虹[1] 丁建勇[1] 卢春来[1] 古杰[1] 

机构地区：[1]复旦大学附属中山医院胸外科,上海200032

出　　处：《复旦学报（医学版）》2014年第3期369-373,共5页Fudan University Journal of Medical Sciences

摘　　要：目的 了解经左胸胸腔镜胸腺切除的可行性、安全性、适应证及操作要点。方法 回顾性分析复旦大学附属中山医院胸外科2005年5月至2013年1月经左胸胸腔镜胸腺切除术58例。其中男性22例,女性36例,平均年龄52.2（18-83）岁。合并左胸其他疾病者3例,合并重症肌无力者7例。结果 全组手术顺利,无围术期死亡。中转开胸2例。平均手术时间107 （35-370） min,平均出血量48 （5-200） mL,术后胸管平均放置时间2.9 （1-6）天,术后住院时间6.4 （3-27）天,术后并发症发生率10.3% （6/58）,医院死亡率为0。术后病理证实胸腺瘤39例、神经鞘膜瘤1例、小细胞神经内分泌癌1例、胸腺囊肿10例、胸腺增生4例、胸腺囊肿伴胸腺增生3例。术后平均随访3.7 （0.3-8.2）年,胸腺瘤胸腔播散1例,死亡2例,7例重症肌无力患者中4例有不同程度缓解。结论 经左胸胸腔镜胸腺切除安全可行,适合于肿瘤主要位于左胸的胸腺瘤或者合并有左胸病变需同时处理的情形。只要找到合适的体位与切口,显露效果并不亚于经右胸手术。Objective To analyze the feasibility,safety,indication and the key point of operative technique of left thoracic approach for thoracoscopic thymectomy.Methods Data of 58 patients who received thoracosopic thymectomy via left thoracic cavity from May 2005 to Jan. 2013 were retrospectively analyzed.The patients were 22 males and 36 females with the mean age of 52.2 （14-61） years.There were 3 patients with another lesion in left thoracic cavity and 7 patients with myasthenia gravis.Results All 58 patients received thoracoscopic thymectomy via left thoracic cavity with 1 patient conversion to thoractomy and 1 patient conversion to sternotomy.The mean operative time was 107 （35-370） min.The mean blood loss was 48 （5-200） mL.The mean thoracic drainage time 2.9（1-6）d.The mean postoperative length of stay was 6.4 （3-27） d.The postoperative morbidity and hospital mortality was 10.3% （6/58） and 0 respectively.Postoperative pathology revealed 39 thymomas,1 nerve sheath tumor,1 small cell neuroendocrine carcinoma,10 thymic cysts,4 thymic hyperplasia,and 3 thymic cysts with thymic hyperplasia.In the followed 0.3-8.2 （mean：3.7） years,metastasis to the left thoracic cavity was found in 1 patient,and 2 patients died, but none of tumor′s business.Four of 7 patients with myasthenia gravis gained symptom relief.Conclusions Left thoracic approach for thoracoscpoic thymectomy is safe and feasible,which is indicated for patient with thymic mass that lies in the left thoracic cavity or with another lesion that lies in the left thoracic cavity and need to be resected synchronously.When optimal position and incisions were made,the exposure of left thoracic approach is not worse than that of right thoracic approach.

关 键 词：胸腺 胸腔镜 胸腔镜手术 胸腺切除术 

分 类 号：R655.7[医药卫生—外科学]