经胸骨L形切口切除前纵隔肿瘤囊肿

The Figure-L Unilateral Transternal Incision for the Treatment of Anterior Mediastinal Tumor and Cyst

目的探讨经胸骨L形切口切除前纵隔肿瘤囊肿的可行性。方法18例前纵隔肿瘤囊肿患者,采用全麻单腔气管插管,胸部正中8～10cm切口,根据肿瘤囊肿的大小及部位,选取第3或第4肋间横断胸骨(向左或向右),直视下切除肿瘤囊肿。结果17例患者经此切口完整切除肿瘤或囊肿,其中3例侵犯邻近肺组织,予以肺部分切除,2例侵犯心包,予以心包部分切除。1例侵犯重要血管,姑息性切除。平均手术时间120min(80～140min),术后均恢复顺利,术后平均住院时间10天,2例肺部感染。术后平均随访时间为24个月(8～36个月)。结论经胸骨L形切口手术创伤较小,术后恢复较快,能在直视下完整切除前纵隔肿瘤或囊肿,是一种可供选择的手术方法。

Objective To explore the feasibility of the small figure - L unilateral transternal incision for the treatment of anterior mediastinal tumor and cyst. Methods Eighteen patients with anterior mediastinal tumor or cyst were enrolled in the study. Under general anesthenia, after a 8to 10 cm middle skin incision was made, a unilateral figure - L partial sternotomy on the side occupied by the tumors was made in the third or forth intercostals space, taking into account the tumors size and location. Tumors were resected with excellent exposure. Results All but one tumors were completely resected during the operation. In 3 cases, tumors encroached on the adjacent lung tissue, and lung tissue was partially resected. In 2cases, tumors invaded the pericardium, and the pericardium was partially removed. Mean operating time was 120 minutes（80 - 140 minutes）. The mean time of hospital stay was 10 days after the operation, and there was no complications. All patients were alive with a mean follow - up period of 24months（8 -36 months）. Conclusions The figure - L unilateral sternotomy is an effective and useful minimally invisive approach for anterior mediastinal tumors.