胸腔镜胸腺切除治疗巨大实性胸腺瘤

Video-assisted Thoracoscopic Surgery for Bulky Solid Thymomas

目的探讨完全电视胸腔镜（video-assisted thoracoscopic surgery,VATS）切除巨大胸腺瘤的可行性和安全性。方法2003年3月~2009年3月,对16例经CT测量最大径≥5 cm的＂巨大＂实性非侵袭（或轻微侵袭）性胸腺瘤进行全胸腔镜手术切除,范围包括肿瘤和整个胸腺,合并重症肌无力等瘤外表现者同时清除前纵膈脂肪组织。结果15例完成全胸腔镜下胸腺切除术,1例因怀疑侵犯左无名静脉而中转开胸。肿瘤最大径5~10 cm,平均7.1 cm。手术时间65~195 min,平均134.1 min。胸腔引流时间1~6 d,平均2.9 d。术后住院3~13 d,平均5.3 d。全组无严重并发症。中转开胸病例术后接受总剂量64 Gy的放疗。15例随访5~75个月,平均31.3月,无复发或转移。结论对于有经验的术者,胸腔镜下切除非侵袭的巨大胸腺瘤是可行和安全的,以往认为的以肿瘤大小界定的禁忌证值得商榷。

Objective To evaluate the efficacy and safety of completely video-assisted thoracoscopic surgery（VATS） in the treatment of bulky solid thymomas.Methods From March 2003 to March 2009,16 consecutive patients with none or less invasive ＂bulky＂ solid thymomas（maximum diameter over 5 cm shown by CT scan）,received thymectomy through VATS.Total thymectomy was routinely performed（extended thymectomy for the patients with paraneoplastic symptoms such as myasthenia gravis）.Results The VATS was successfully completed in all the cases except in one who was converted to open surgery because of suspected involvement of the left anonymous vein.The maximum diameter of the tumors ranged from 5 to 10 cm with a mean of 7.1 cm.The mean operation time was 134.1 min（ranged from 65 to 195 min）.After the operation,the chest drainage tube was withdrawn in a mean of 2.9 days（1-6 days）.The patients were discharged from hospital in 3 to 13 days（mean,5.3 days）.In this series,no severe complications occurred.The patient who underwent open chest surgery received radiotherapy with a total dosage of 64 Gy.Fifteen patients were followed up for 5 to 75 months（mean,31.3 months）,during which no one had recurrence or metastasis.Conclusions With experienced hands,resection of noninvasive bulky solid thymomas by complete thoracoscopy is feasible and safe.The contraindication of the procedure determined tumor size needs to be further discussed.