胸腔镜在小儿纵膈肿物治疗中的应用研究  

Thoracoscopic surgery for pediatric mediastinal tumors

作　　者：刘树立[1] 黄柳明[2] 张军[1] 李旭[1] 李龙[1] 管考平[1] 杨轩[1] 陈震[1] 张震[1] 魏延栋[1] 

机构地区：[1]首都儿科研究所外科,北京100020 [2]北京军区总医院附属八一儿童医院外科

出　　处：《中华小儿外科杂志》2015年第6期435-438,共4页Chinese Journal of Pediatric Surgery

基　　金：国家十一五科技支撑计划课题（2006BAI05A06）;卫生部行业专项课题（201402007）;北京市医院管理局“扬帆计划”课题（ZY201306）

摘　　要：目的 探讨胸腔镜手术治疗小儿纵膈肿物的可行性、安全性、有效性.总结胸腔镜手术治疗小儿纵膈肿物经验.方法 回顾性分析2006年7月至2013年9月,应用胸腔镜手术治疗小儿纵膈肿物27例的临床资料.本组术前均行增强CT检查,肿物直径4.5～12 cm,平均（6.7±1.7） cm.术前CT诊断畸胎瘤10例,支气管源性囊肿6例,食管源性囊肿7例,神经母细胞瘤4例.全部患儿实施胸腔镜肿物切除术,术中病理冰冻切片检查确诊.结果 全部患儿顺利完成胸腔镜纵膈肿物切除术,无中转开放手术患儿,肿物完整切除.手术时间90～220 min,平均（137.9±33.3） min.估计出血量5～80 ml,无输血患儿.术后当天进水,第1天进食;住院时间3～7 d,平均（4.6±1.2）d.术后无并发症发生,无围手术期死亡患儿.术后病理检查报告,切除完全,边缘无肿瘤组织残留.良性畸胎瘤肿瘤10例、支气管源性囊肿7例、食管源性囊肿7例,节神经母细胞瘤4例,与CT诊断基本符合.术后随访4个月～7年,平均（37.0±21.7）个月,患儿健康生存,无肿瘤复发.结论 选择适宜的纵膈肿物患儿应用胸腔镜手术治疗是安全、可行的.术者胸腔镜操作技术熟练、纵膈肿瘤切除经验丰富及可靠影像学技术支持,是手术安全、成功的保障.根据术中情况必要时应及时中转开胸,不强求胸腔镜切除.术前全面准确的评估病情可降低中转开胸率.恶性肿瘤手术例数尚少、随访时间尚短,胸腔镜手术应谨慎.Objective To explore the feasibility,safety and efficacy of thoracoscopically resecting mediastinal tumors in children.Methods A total of 27 children with mediastinal tumors between July 2006 and September 2013 were recruited to undergo thoracoscopic surgery.The tumors were cystic or solid with a mean diameter of 6.7 ± 1.7 （4.5-12）crn.And 19 of them were symptomatic.The most common site was upper mediastinum.Results All mediastinal tumors were completely excised.There was no conversion into thoracotomy.The mean operative duration was （137.9 ± 33.3）（90-220） min.There was no operative complication with a minimal amount of blood loss.Neither pneumothorax nor hydrothorax occurred.With a smooth recovery,the mean postoperative hospital stay was 4.6 ± 1.2 （3-7） days.During a mean follow-up period of 37.0 ± 21.7 （4-84） months,neither complication nor recurrence occurred.Conclusions Throcoscopic excision of mediastinal tumors is both feasible and safe in children.And this mini-invasive approach should be considered as a first-line therapeutic option.Proper preoperative case selection may prevent a conversion into thoracotomy due to huge mass and adhesions.

关 键 词：胸腔镜检查 纵膈囊肿 神经母细胞瘤 畸胎瘤 随访研究 

分 类 号：R734.5[医药卫生—肿瘤]