经胸骨L形微创切口治疗前纵隔肿瘤

The figure-L unilateral transternal small incision for the treatment of anterior mediastinal tumor

目的探讨经胸骨L形微创切口切除前纵隔肿瘤的可行性及优势.方法 24例前纵隔肿瘤患者,采用全麻单腔气管插管,胸部正中6～10cm切口,根据肿瘤的大小及部位,选取第2或第3肋间向左或右横断胸骨,直视下切除肿瘤.结果所有患者均经此切口完成手术,彻底切除肿瘤,其中8例侵犯邻近肺组织,予以肺部分切除,6例侵犯心包,予以心包部分切除,平均手术时间106min(80～125min),术后均恢复顺利,术后平均住院时间5天,无并发症发生.术后平均随访时间为14个月(3～24个月),无一例死亡.结论经胸骨L形微创切口手术创伤小,术后恢复快,能在直视下完整解剖切除前纵隔肿瘤,是一种可供选择的微创手术方法.

Objective To explore the feasibility and advantage of the small figure-L unilateral transternal incision for the treatment of anterior mediastinal tumor. Methods Twenty-four patients with anterior mediastinal tumor were enrolled in the study. Under general anesthesia, after a 6 to 10 cm midline skin incision was made, a unilateral figure-L partial sternotomy on the side occupied by the tumor was made in the second or third intercostals space, taking into account the tumor size and location. Tumors were resected with excellent exposure. Results All tumors were completely resected during the operation. In 8 cases, tumors encroached on the adjacent lung tissue, and lung tissue was partially resected. In 6 cases, tumors invaded the pericardium, and the pericardium was partially removed. Mean operating time was 106 minutes （80-125 minutes）. The mean time of hospital stay was 5 days after the operation, and there was no complication. All patients were alive with a mean follow-up period of 14 months （3-24 months）. Conclusion The figure-L unilateral mini-sternotomy is considered as an effective and useful minimally invasive approach for anterior mediastinal tumors.