完全电视胸腔镜手术诊治113例原发性纵隔肿瘤的临床分析

Complete video-assisted thoracoscopy for primary mediastinal tumor: report of 113 cases

目的 探讨完全电视胸腔镜手术（video-assisted thoracoscopic surgery,VATS）在切除纵隔肿瘤,尤其是大体积和侵袭性纵隔肿瘤中的临床价值。方法 回顾性分析了我科2011年1月至2014年12月经VATS行纵隔肿瘤切除手术患者113例,男性51例,女性62例。年龄9～78岁（中位年龄50岁）,肿瘤最大径线值1.5～13 cm（中位径线值4 cm）。记录围术期各项观察指标并行统计学分析。结果 113例纵隔肿瘤均在VATS下完成,术中出血量10～800 m L（中位出血量100 m L）,术后住院时间2～18 d（中位术后住院时间5 d）,手术时间40～330 min（中位手术时间90 min）。统计分析指出直径〉6 cm的纵隔肿瘤共28例（占24.8%）,围术期无死亡和相关并发症发生,术后随访未见肿瘤复发。相对于直径〈6 cm的肿瘤,直径〉6 cm的纵隔肿瘤手术时间延长（P〈0.001）,术中出血量增加（P〈0.001）,但术后住院时间未见明显延长。4例侵袭性纵隔肿瘤（3例恶性胸腺瘤和1例畸胎瘤）行VATS,围术期无死亡病例和并发症发生,术后随访1例复发。结论 VATS广泛应用于纵隔肿瘤的切除,同时大体积以及侵袭性纵隔肿瘤不是VATS的禁忌。在一定条件下,VATS对大体积以及侵袭性纵隔肿瘤的治疗可以达到和传统开放手术相似的治疗效果,同时能够降低手术创伤,减轻术后疼痛,缩短患者住院时间以及减少术后并发症,且安全、有效、经济。

Objective To investigate the clinical Outcomes of complete video-assisted thoracoscopic surgery （VATS） in treatment of mediastinal tumor, especially for bulky and invasive masses. Methods A total of 113 patients （including 51 males and 62 females, at a median age of 50, ranging from 9 to 78） undergoing VATS for primary mediastinal tumor in our department from January 2011 to December 2014 were enrolled in this study. The diameter of the mass ranged from 1.5 to 13 cm, with a median of 4 cm. Peri- operative indicators were recorded and evaluated statistically. Results Successful operation was carried out in all the cases by VATS, with intra-operative bleeding amount of 10 to 800 mL （median amount 100 mL）. The hospital stay ranged duration from 2 to 18 d （median duration 5 d）. The intra-operative duration ranged from 40 rain to 330 rain, with median of 90 min. For the 28 cases with masses 〉6 cm in size （24.8%） , no peri-operative death or related complications were found, neither tumor recurrence during follow-up. But the operative time was prolonged and intra-operative bleeding volume was increased （ P 〈 0. 001 ）, but there was no change in hospital stay of length when compared with the cases with mass with diameter 〈 6 cm. No mortality and complication occurred for 4 cases of invasive teratoma） under VATS, but tumor recurrence was seen in 1 tumor （3 cases of malignant thymoma and 1 of case during follow-up. Conclusion VATS can be widely used in the surgery for mediastinal tumor, and bulky and invasive mediastinal masses are not its contraindication. The efficacy of VATS for bulky and invasive mass is paralleled with that of open surgery. Meanwhile, VATS leads mini-invasiveness, less pain, shortened hospital stay and less complication. VATS is a safe, efficient and economical treating strategy for patients with bulky and invasive mediastinal tumor.