胸腔镜手术切除纵隔肿瘤66例分析

Video-assisted thoracic surgery for mediastinal tumor: Report of 66 cases

目的：探讨胸腔镜手术治疗纵隔肿瘤的临床疗效及应用价值。方法：回顾性分析皖南医学院弋矶山医院2014年4月～2016年4月经胸腔镜手术治疗纵隔肿瘤66例,其中男性30例,女性36例;年龄18～78岁,平均（49±14）岁。统计平均手术时间、术中出血量、胸管引流时间、术后住院时间、术后并发症等指标。结果：全胸腔镜下完成手术56例,其中单操作孔18例,胸腔镜辅助小切口完成8例,中转开胸2例。手术时间25～165 min,平均（92±33）min,术中出血量10～600 m L,平均（95±36）m L,胸管引流时间1～10 d,平均（3.5±1.5）d,术后住院时间3～28 d,平均（7.6±2.7）d。术后并发肺部感染4例,肌无力危象2例。围手术期无死亡病例,术后随访6～8个月无复发病例。结论：胸腔镜下手术切除纵隔肿瘤是安全、可行的。术者应根据肿瘤位置、大小制订合适的手术方案,以降低手术风险。

Objective： To assess the clinical efficacies and values of video-assisted thoracic surgery（ VATS） in resection of mediastinal tumor.Methods：Retrospective analysis was performed in 66 cases of mediastinal tumor treated with VATS in our hospital between April of 2014 and 2016. Of the 66 patients,30 were males,and 36,females. The age ranged from 18 to 78 years,with a mean（ 49±14） years. The index were analyzed regarding the average operative time,intraoperative blood loss,time of chest tube maintenance,post-operative hospital stay and complications. Results： VATS was were successfully performed in 56 patients,in whom 18 received uniport VATS procedure,8 were finished by video-assisted mini-thoracotomy,and another 2 were converted to thoracotomy. Mean operative time was（ 95±36） min. Intraoperative blood loss ranged between 10 m L and 600 m L with a mean of（ 95±36）m L. Drainage extubation was from 1 to 10 days with an average of（ 3.5±1.5） days. Post-operative hospital stay w varied from 3 to 28 days with a mean of（ 7.6±2.7） days. Postoperative complications were associated with lung infection in 4 cases,myasthenia crisis in 2. There was no perioperative death.Follow-up in 6 to 8 months showed no single case of relapse. Conclusion： VATS can be safe and effective for resection of the mediatinal tumor. However,surgical program should be tailored to the tumor site and tumor size in order to reduce the surgical risks.