剑突下“三孔式”前纵隔胸腺疾病手术模块化操作及标准流程技术要点——唐都经验  

Technical points of modular operation and standard procedure for three-port anterior mediastinal thymic disease surgery via subxiphoid approach:Experience of Tangdu Hospital

作　　者：张继朋 周勇安 赵晋波 贾澄辉 徐欣瑶 向光宇 李家贺 卢强 ZHANG Jipeng;ZHOU Yongan;ZHAO Jinbo;JIA Chenghui;XU Xinyao;XIANG Guangyu;LI Jiahe;LU Qiang(Department of Thoracic Surgery,Tangdu Hospital,Air Force Medical University,Xi'an,710038,P.R.China;Basic Medical College,Air Force Medical University,Xi'an,710032,P.R.China)

机构地区：[1]空军军医大学唐都医院胸腔外科,西安710038 [2]空军军医大学基础医学院,西安710032

出　　处：《中国胸心血管外科临床杂志》2024年第12期1735-1742,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：陕西省技术创新引导重点专项(2021QFY01-03);空军军医大学唐都医院临床研究重大项目(2021LCYJ008);空军军医大学唐都医院新技术新业务重点项目(XJSXYW2021001)。

摘　　要：外科手术是治疗前纵隔胸腺疾病的重要方法。随着微创技术的快速发展,绝大多数胸腺疾病均可通过胸腔镜外科实现病变的完整切除。实践证明,经剑突下“三孔式”前纵隔胸腺切除术是目前治疗前纵隔胸腺肿瘤较为理想的手术方式。手术操作主要集中在前、上纵隔部位,可彻底显露纵隔及两侧解剖结构,术中出血少、安全性高、创伤极小、术后疼痛轻、住院时间短,较传统的经胸胸腔镜手术和经胸骨劈开切除手术有明显优势。但该手术方式的操作入路、视野范围、术中注意事项等完全不同于以往的胸腔镜手术,也有别于其他中心采用的经剑突下单孔入路手术。我们总结本中心10年的手术经验,形成了模块化的手术操作模式,并将其操作流程标准化,本文将相关的操作要点和经验进行分享和探讨。Surgery is an important treatment for the anterior mediastinal disease.With the rapid development of minimally invasive techniques,complete resection of the lesion in most patients with thymic disease can be achieved through thoracoscopic surgery.Practice has proved that the three-port resection of anterior mediastinal thymus disease via the subxiphoid approach is an ideal surgical method for the treatment of anterior mediastinal thymic tumors at present,which has strong popularization and popularity and can benefit the patients.The procedure focuses primarily on the anterior and upper mediastinum and can thoroughly expose the anatomy of the mediastinum and both sides,with minimal intraoperative bleeding,high safety,minimal trauma and postoperative pain,and a short hospital stay.It has clear advantages over conventional thoracic open-heart surgery and transversal resection.However,the surgical approach and field of view,and intraoperative precautions of this procedure are completely different from those of previous thoracoscopic procedures,and from the subxiphoid single-port approach adopted by other centers.Based on 10 years of surgical experience at our center,a modular mode of surgical operation has been developed and its procedure has been standardized.This paper will share and discuss relevant operational points and experiences.

关 键 词：剑突下入路 胸腺切除术 “三孔式”手术 模块化 胸腺疾病 重症肌无力 

分 类 号：R655[医药卫生—外科学]