电视胸腔镜手术与开胸手术在纵隔肿瘤治疗中的应用

The Application of Video-assisted Thoracic Surgery and Thoracotomy in the Treatment of Mediastinal Tumors

目的通过比较电视胸腔镜手术(VATS)与开胸手术(TH)治疗纵隔肿瘤的优缺点,探讨VATS手术治疗纵隔肿瘤的临床应用价值。方法回顾性分析2008年11月至2013年3月由新疆医科大学第一附属医院胸外科收治的330例纵隔肿瘤患者,其中154例行VATS手术,176例行TH手术,所有病例经病理诊断为胸腺瘤、畸胎瘤、神经源性肿瘤,随访1年。结果 VATS组和TH组无一例死亡,VATS胸腺瘤手术1例术后1年内复发,TH胸腺瘤手术2例术后1年内复发。VATS组与TH组比较,胸腺肿瘤切除术中出血量[(100.0±35.0)mL vs(150.0±40.0)mL]d、术后第1日胸管引流量[(80.0±30.0)mL vs(100.0±36.0)mL]min、术后胸腔引流时间[(3.0±0.5)d vs(4.0±0.8)d]、术后住院时间[(5.0±0.6)d vs(6.5±0.7)d]min、术后24 h VAS评分[(3.0±0.5)vs(5.0±0.9)]均少于TH组;畸胎瘤切除手术时间[(70.3±15.4)min vs(86.5±20.6)min]、术中出血量[(100.0±35.0)mL vs(150.0±40.0)mL]、术后第1日胸管引流量[(80.0±30.0)mL vs(100.0±36.0)mL]、术后胸腔引流时间[(3.0±0.5)d vs(4.0±0.8)d]、术后住院时间[(5.0±0.6)d vs(6.5±0.7)d]、术后24 h VAS评分[(3.0±0.5)vs(5.0±0.9)]也均少于TH组;神经源性肿瘤切除手术时间[(112.3±48.8)min vs(135.3±60.8)min]、术中出血量[(94.0±82.5)mL vs(398.7±202.2)mL]、术后第1日胸管引流量[(110.5±80.6)mL vs(160.8±110.7)mL]、术后胸腔引流时间[(3.5±0.8)d vs(4.3±1.9)d]、术后住院时间[(4.7±2.4)d vs(6.5±1.8)d]、术后24 h VAS评分[(2.7±0.5)vs(4.6±0.9)]仍均少于TH组。结论 VATS治疗纵隔肿瘤,在术后复发率方面与开胸手术无差别,在术中及术后一般情况评价优于常规开胸。

Objective To compare the clinical effects of VATS and thoracotomy in the treatment effect of mediastinal tumor, and discuss the clinical application value of VATS for mediastinal tumor. Methods A retrospective analysis of 330 cases of mediastinal tumors treated in the Department of Thoracic Surgery in Xinjiang Medical University First Affiliated Hospital from Nov. 2008 to Mar. 2013 was done, including 154 cases treated with VATS and 176 cases treated with thoracotomy. All patients have been pathologically diag- nosed as thymoma or teratoma or neurogenic tumors and were followed up for 1 year. Results There was not any death case in both VATS group and thoracotomy group, and there was 1 case of thymoma recurrence within 1 year after VATS,2 cases of thymoma recurrence within 1 year after thoracotomy. VATS group com- pared with thoraeotomy group：for thymoma,blood loss were[ （ 100.0 ±35. O） mL vs（ 150.0 ±40.0） mL] , postoperative 1 day chest tube drainage were [ （ 80.0 ± 30 ） mL vs （ 100.0 ± 36.0 ） mL ] , postoperative chest drainage time were [ （ 3.0 ± 0.5 ） d vs （4.0 ± 0.8 ） d ] , postoperative hospital stay were [ （ 5.0 ± 0. 6 ） d vs （ 6.5 ± O. 7 ） d ] , postoperative 24 h VAS score were [ （ 3.0 ± 0.5 ） vs （ 5.0 ± 0.9 ） ] （ P 〈 0.05 ） , the VATS group were all less than the TH group ; for teratoma, time of operation were E （70- 3 ± 15.4 ） min vs （ 86.5 ± 20.6 ） min ], blood loss were [ （ 100.0 ± 35.0 ） mL vs （ 150.0 ± 40.0 ） mL ], cpostoperative 1 day chest tube drainage were [ （ 80.0 ± 30.0 ） mL vs （ 100.0 ± 36.0 ） mL ] , postoperative chest drainage time were [ （ 3.0 ± 0.5 ） d vs （4.0 ± 0.8 ） d ], postoperative hospital stay were [ （5.0 ± 0.6） d vs （6.5 ± 0.7 ） d ], postoper- ative 24 h VAS score were [ （ 3.0 ± 0.5 ） vs （ 5.0 ± 0.9 ） ], the VATS group were all less than the TH group;for neurogenic tumors,time of operation were[ （ 112.3 ±48.8） min vs （ 135.3 ±60.8） min] ,blood loss were[ （94.0 ± 82.5 ） mL vs （398.7 ± 202.2 ） mL] , postoperative 1 day chest tube drainage were [ （ 110.5 ± 80.6 ） mL vs （ 160.8 ± 110.7 ） mL ], postoperative chest drainage time were [ （ 3.5 ± 0.8 ） d vs （4.3 ± 1.9 ） d ] , postoperative hospital stay were [ （4.7 ± 2.4 ） d vs （6.5 ± 1.8 ） d ±, postoperative 24 h VAS score were[ （2.7 ±0.5） vs（4.6 ±0.9） ] ,the VATS group were all less than the TH group. Conclu- sion There was no obvious difference in tumor recurrence rate between the VATS and thoraetomy for trea- ting mediastinal tumors, while VATS has a better intraoperative and postoperative general condition than tho- raeotomy.