单操作孔全胸腔镜手术在纵隔肿物切除中的应用

Single-port Video-assisted Thoracoscopic Surgery for Mediastinal Tumor Resection

目的探讨单操作孔全胸腔镜纵隔肿物切除手术的优势及临床价值。方法回顾性分析2006年6月~2014年6月收治的125例行电视胸腔镜手术（video-assisted thoracoscopic surgery,VATS）切除纵隔肿物的患者,其中单操作孔VATS组56例,常规三孔VATS组69例,比较两组患者的手术时间、术中出血量、术后ICU监护治疗时间、术后胸腔引流管放置时间、术后疼痛感、术后住院时间、术后并发症等临床资料。结果 125例患者均手术顺利,无中转开胸。两组患者手术时间、术后ICU监护治疗时间、术后胸腔引流管放置时间、术后住院时间差异均无统计学意义;单操作孔VATS组术中出血量、术后疼痛评分均低于三孔VATS组,差异有统计学意义（均P〈0.05）。患者无围手术期死亡,三孔VATS组出现1例肺部感染、1例心率失常,单操作孔VATS组出现1例肺部感染,余患者术后恢复顺利。随访3个月~8年,15例胸腺瘤合并重症肌无力患者（单操作孔VATS组7例,常规三孔VATS组8例）中11例患者肌无力症状术后不同程度好转（单操作孔VATS组6例,常规三孔VATS组5例）,4例患者术后肌无力症状无明显改善（单操作孔VATS组1例,常规三孔VATS组3例）,15例患者术后均门诊口服溴吡啶斯的明治疗。125例患者,除常规三孔VATS组1例伤口持续性疼痛半年,给予理疗止痛等治疗好转外,其他患者均恢复良好,未见复发及其他并发症。结论单操作孔VATS切除纵隔肿物在技术上是安全、可行的,与常规三孔VATS相比,具有创伤小、恢复快等优点。

Objective To explore the advantages and clinical value of single-port video-assisted thoracoscopic surgery（VATS）for the treatment of mediastinal tumor.Methods Clinical data of 125 patients with mediastinal tumor who were treated between Jun.2006 to Jun.2014 in our hospital were retrospectively analyzed.Among these patients,56 were treated by single working pore VATS,and the other 69 by conventional three-port VATS.The operation time,operative blood loss,drainage time,time in ICU,painful feeling post-operation,hospital stay,and complications were compared between the two groups.Results VATS was successfully accomplished in all the 125 patients.No one was converted to open thoracotomy.The operation time,drainage time,time in ICU,and complications in single-pore VATS group were not statistically different from those in conventional VATS group.There were significant differences in operative blood loss and painful feeling post-operation between the two groups（P0.05）.No patients died during the perioperative period.One patient developed pulmonary infection and 1arrhythmia in conventional VATS group after operation.Only 1case had pulmonary infection in single-pore VATS group.All the patients were followed up for 3months to 8years.Eleven patients of all 15 patients with thymoma and myasthenia gravis（7patients in single-pore VATS group and 8in conventional VATS group）had partial remission（6patients in singlepore VATS group and 5in conventional VATS group）,and myasthenia was not improved in 4patients after operation（1in single-pore VATS group and 3in conventional VATS group）.All the 15 patients were given pyridostigmine bromide after operation.One patient in conventional VATS group reported wound pain for half year and recovered after given physical therapy and analgesics.All the other patients recovered smoothly and no recurrence was found.Conclusion Single-port VATS is a safe and feasible procedure with the advantages of minimal invasion and quick recovery,thus providing better choice for patients with mediastinal tumor.