剑突下入路单孔胸腔镜在前纵隔肿瘤手术中的应用  

Application of xiphoid single hole video-assisted thoracoscopic surgery in the treatment of anterior mediastinal tumor

作　　者：许彬东[1] 陈豪[1] 黄国忠[1] 张强[1] 陈鹏飞 蔡茂恩[1] 姚金梅[1] XU Bindong;CHEN Hao;HUANG Guozhong;ZHANG Qiang;CHEN Pengfei;CAI Maoen;YAO Jinmei(Department of Cardiothoracic Surgery,Affiliated Hospital of Puitan University,Putian 351100,China)

机构地区：[1]莆田学院附属医院胸心外科,福建莆田351100

出　　处：《山东第一医科大学（山东省医学科学院）学报》2022年第1期24-28,共5页Journal of Shandong First Medical University ＆ Shandong Academy of Medical Sciences

基　　金：莆田市科技计划(2018S3F011)。

摘　　要：目的探讨剑突下入路单孔胸腔镜在前纵隔肿瘤手术中的应用价值。方法回顾性分析2015年6月至2020年6月莆田学院附属医院胸心外科收治的前纵隔肿瘤54例患者的临床资料。其中男性39例,女性15例,年龄45~79岁,平均年龄(64.9±7.5)岁,肿瘤的直径为2.0~5.0 cm,平均(3.47±0.78)cm。手术方法为剑突下入路单孔胸腔镜手术。结果54例患者均顺利完成手术,无中转开胸手术,无死亡病例。围手术期无胸腔内大出血、纵隔感染、膈神经损伤等严重并发症。手术操作时间为62~380 min,平均(134.5±60.1)min。术中出血量20~150 mL,平均(71.6±26.2)mL,术后胸液引流量30~680 mL,平均(384.4±118.4)mL,留置胸管时间26~90 h,平均(44.4±16.8)h,术后住院时间为3~8天,平均(4.7±1.4)天,术后1天和7天疼痛视觉模拟量表评分分别为(6.5±0.84),(2.9±0.77)分。结论对于病灶包膜完整且肿瘤直径≤5 cm的前纵隔肿瘤,剑突下入路单孔胸腔镜手术在技术上是可行的,而且安全有效,值得临床推广。Objective:To explore the application of xiphoid single hole video-assisted thoracoscopic surgery in the treatment of anterior mediastinal tumor.Methods:Clinical data were reviewed in 54 cases of anterior mediastinal tumor from June 2015 to June 2020 in the hospital.Thirty-nine cases were male and 15 were female,and the median age was(64.9±7.5)years(range 45~79 years).Diameter of tumor was(3.47±0.78)cm(range 2.0~5.0 cm).The operation method was single-hole thoracoscopic surgery through the subxiphoid approach.Results:Among 54 cases,there were no hospital deaths and thoracotomy surgery in the operation.There were no serious complications,such as massive chest hemorrhage,mediastinal infection and phrenic nerve injury during perioperative period.Operation time of operation was(134.5±60.1)min(range 62~380 min),the bleeding amount in the operation was(71.6±26.2)mL(range 20~150 mL),and the volume of chest drainage after operation was(384.4±118.4)mL(range 30~680 mL).The decannulation time of pleural canals was(44.4±16.8)h(range 26~90 h).Hospitalized time after operation was(4.7±1.4)d(range 3~8 d).The pain score of these patients one day after operation was 6.5±0.84.The pain score of these patients seven days after operation was 2.9±0.77.Conclusion:For non-invasive thymoma,benign thymic tumor and early malignant tumor of anterior mediastinum,single-hole thoracoscopic surgery through subxiphoid approach is technically possible,safe and effective,and worth being generalized in clinic.

关 键 词：单孔 剑突下 胸腔镜 手术 前纵隔肿瘤 

分 类 号：R734.5[医药卫生—肿瘤]