电视胸腔镜手术治疗胸膜孤立性纤维瘤的临床分析

Clinical analysis of thoracoscopic treatment for solitary fibrous tumors of the pleura

目的探讨电视胸腔镜手术(VATS)治疗胸膜孤立性纤维瘤(SFTP)的价值,总结微创治疗经验。方法 1999年2月至2010年10月VATS治疗SFTP患者19例,其中全胸腔镜手术14例,胸腔镜辅助小切口(6～8cm)手术3例,胸腔镜联合后外侧大切口(15cm)手术2例。结果全组均完整切除肿瘤,手术顺利,无并发症及围手术期死亡。术中证实13例肿瘤起源于脏层胸膜有蒂,5例起源于壁层胸膜无蒂宽基底,1例起源于纵隔胸膜有蒂。主要诊断依据免疫组化分析,19例患者的Vimentin和CD34均阳性表达;病理诊断良性17例,恶性2例。平均住院时间6d(4～11d)。术后平均随访51个月,无复发和转移。结论 VATS创伤小,可作为治疗SFTP的首选方法,值得推荐。

Objective To discuss the value of video-assisted thoracoscopic surgery （ VATS ） in treatment of the solitary fibrous tumors of the pleura （ SFTP ） and to summarize our experience of minimally invasive treatment. Methods Between February 1999 and October 2010 , 19 patients with SFTPs underwent VATS at our department （ surgical excision was performed by c-VATS in 14 patients and by VATS with a small incision （ 6 - 8 ） cm in 3 patients and by VATS with posterolateral thoracotomy in 2 patients. Results All surgery of patients are successful, with complete excision of the tumour. There was no complication and death of perioperative period.During the operation, it was found that thirteen tumors had pedunculate originated from the visceral pleura and five tumors from the parietal pleura presented a broad base of attachment, one tumor originating from the mediastinal pleura had pedunculate. Immunohistochemical analysis revealed positivity for vimentin and CD34 in all tumors. Pathological diagnoses was benign in 17 patients and malignant in 2 patients. Mean length of hospital stay was 6 days （ range, 4-11 days ）. The median follow-up period was 51 months during which no recurrence or metastasis of SFTPs developed in all patients. Conclusions With less injury and the length of incision, VATS can be the preferred option to treat solitary fibrous tumors of the pleura （ SFTP ） , VATS is worth to recommending.