电视胸腔镜手术治疗胸腺瘤75例

Video-assisted Thoracoscopic Surgery for Thymoma:A Report of 75 Cases

目的探讨电视胸腔镜手术治疗胸腺瘤的临床价值。方法 2008年1月～2012年8月对75例经CT测量肿瘤最大径1～11 cm的胸腺瘤在电视胸腔镜下施行胸腺瘤切除,腋前线第5肋间做1.0 cm观察孔,主、副操作孔长1.5 cm,常规为第3肋间腋前线及第5肋间锁骨中线,可适当调整。电钩沿膈神经前纵行切开术侧纵隔胸膜达瘤体上下极,钝性分离暴露瘤体后处理肿物下极并游离至对侧纵隔胸膜。自下而上游离并处理胸腺静脉后完整切除瘤体。对合并免疫相关疾病的患者除切除瘤体与胸腺外进行前纵隔脂肪清扫。结果围术期无死亡病例,57例全胸腔镜下完成,17例在胸腔镜辅助小切口下完成,1例因术中左无名静脉破裂出血而中转开胸。术后并发肺部感染6例,肌无力危象1例,静脉血栓形成2例。66例随访7～58个月,平均12.8月,1例C型胸腺瘤术后8个月复发,第15个月死于全身转移,余65例无复发或转移。29例合并MG者,14例完全缓解,13例部分缓解,2例无改善;2例合并PRCA者,1例部分缓解,1例无改善。结论胸腔镜下胸腺瘤切除术可行。

Objective To explore the clinical value of video-assisted thoracoscopic surgery in the treatment of thymoma.Methods Between January 2008 and August 2012,we performed video-assisted thoracoscopic thymectomy on 75 patients whose thymomas ranged from 1 to 11 cm as was shown by CT scan.The observation port was made at the 5th intercostal space on the anterior axillary line with a length of 1 cm,and the other two operating ports with a length of 1.5 cm were made at the third intercostal anterior axillary line and the fifth rib collarbone midline respectively.The location of operating port could be adjusted.Using electric hook to cut the mediastinal pleura along the front of the phrenic nerve,we exposed the tumor with blunt dissection and separated it from the downside to the contralateral mediastinal pleura.After the thymic vein being disposed,the thymoma was resected.The patients with immunity related diseases received thymoma resection and anterior mediastinal fat cleaning.Results No patients died during the perioperative period.Video-assisted thoracoscopic surgery was completed successfully in 57 cases,and video-assisted minithoracotomy was carried out in 17 cases,while 1 case was converted to open thoracotomy due to left anonymous vein bleeding.Postoperative pulmonary infection occurred in 6 cases,myasthenia gavis in 1 case and venous thrombosis in 2 cases.66 patients were followed up for 7 to 58 months（mean： 12.8 months）.One case recurred 8 months after operation and died 15 months after operation because of general matastasis.Other 65 cases had no recurrence or matastasis.Of the 29 patients complicated with myasthenia gravis,14 patients received complete response,13 partial response,and 2 stable disease.Among the 2 patients complicated with pure red-cell anemia,1 patient received partial response,and the other stable disease.Conclusions Video-assisted thoracoscopic surgery for thymoma is feasible and can be promoted to wider clinical application.