单操作孔全胸腔镜手术在小儿后纵隔肿瘤中的应用

Single Utility Port Video-assisted Thoracoscopic Surgery for Posterior Mediastinal Tumor in Children

目的：探讨单操作孔全胸腔镜手术治疗小儿后纵隔肿瘤的疗效。方法2011年1月～2014年12月对36例患儿行单操作孔全胸腔镜下后纵隔肿瘤切除术，患侧卧位，腋中线第7～8肋间做腔镜孔，腋前线第3～5肋间做2～3 cm 操作孔，选择电钩或超声刀沿肿瘤边缘分离组织，避开周围重要血管、神经、乳糜管等结构，完整切除肿瘤。结果所有患儿均在单操作孔下完成手术，无中转开胸。手术时间56～133 min，平均82 min；术中出血量10～50 ml，平均25 ml；术后住院时间3～10 d，平均6．2 d。住院期间无死亡，2例术后出现霍纳综合征，其余患儿恢复顺利。术后病理：单纯囊肿3例，畸胎瘤1例，神经纤维瘤2例，节细胞神经瘤22例，节细胞神经母细胞瘤6例，神经母细胞瘤2例。所有患儿随访1～43个月，平均19个月，无肿瘤复发，1例霍纳综合征患儿半年后恢复正常，1例无明显好转。结论单操作孔全胸腔镜下治疗小儿后纵隔肿瘤疗效满意。

Objective To explore the efficacy of single utility port video-assisted thoracoscopic surgery（VATS）for posterior mediastinal tumor in children. Methods From January 201 1 to December 2014,a total of 36 pediatric patients with posterior mediastinal tumor underwent single utility port VATS in our hospital.All the patients were placed at diseased side lying position.The operation was carried out via 2 incisions：one incision was made in the 7th or 8th intercostal space on the midaxillary line,and the another incision 2 -3 cm in length was made in the 3 -5 intercostal space on the anterior axillary line.The tumor was isolated along the margin with electric hook or ultrasonic knife,avoiding injury to vessels,nerves and lacteal around the tumor,until completely resection the tumor. Results All the operations were completed via the single utility port,with no conversion to thoracotomy.The operation time was 56 -133 min （average,82 min）,the blood loss in the operation was 10 -50 ml （average,25 ml）,and the hospitalization time after operation was 3 -10 d （average,6.2 d）.No patient died during hospitalization.Horner syndrome occurred in 2 cases after operation,and the remaining cases recovered uneventfully.Pathological types of tumors included 3 cases of simple cyst,1 case of teratoma,2 cases of neurofibroma,22 cases of ganglioneuroma,6 cases of ganglioneuroblastoma,and 2 cases of neuroblastoma.All the patients were followed up for 1 -43 （mean,19 months）.There was no case of recurrence.One patient with Horner syndrome recovered 6 months later,and the other had no improvement. Conclusion Single utility port VATS for posterior mediastinal tumor in children has satisfactory treatment effects.