胸腺囊肿的诊断及全胸腔镜手术治疗:附72例报告

The Diagnosis and Video-assisted Thoracoscopic Resection of Thymic Cysts:Analysis of 72 Cases

目的探讨胸腺囊肿的临床特点及胸腔镜手术价值。方法 2001年4月~2012年10月对72例胸腺囊肿施行胸腔镜手术,置入胸腔镜后采用电凝钩与钝头吸引器游离囊肿,辅以钛夹或超声刀处理囊肿蒂部,根据术中情况决定切除范围。结果 CT诊断胸腺囊肿比例51.4%(37/72),其中直径>3 cm组与直径≤3 cm组分别为70.5%(31/44)和21.4%(6/28),有统计学差异(χ~2=16.464,P=0.000);囊液清亮者(n=28)与囊液黏稠者(n=14)分别为67.9%(19/28)和21.4%(3/14),有统计学差异(χ~2=8.066,P=0.005)。全胸腔镜手术71例,因囊肿与周围肺组织致密粘连影响探查及分离中转开胸1例(1.4%)。手术方式包括:胸腺囊肿+胸腺切除术31例,胸腺囊肿+部分胸腺切除术21例,胸腺扩大切除术10例,单纯胸腺囊肿切除术10例,术后无严重并发症或死亡。手术时间(113.1±43.5)min;出血量中位数50.0 ml(5~250 ml)。随访成功率83.3%(60/72),中位随访时间47个月(24~150个月),均未见囊肿复发。结论胸腺囊肿的直径、囊液性质是影响CT诊断准确率的重要因素;胸腔镜手术安全、有效,具有微创优势,切除范围需要根据症状、影像学、术中探查情况和手术切除彻底性综合考虑。

Objective To explore the clinical features of thymic cysts, and the important role of video-assisted thoracoscopic surgery （VATS） in the treatment of thymic cysts. Methods We retrospectively reviewed 72 patients with thymie cysts who had undergone VATS at our institution between April 2001 and October 2012. After the introduction of a thoracoscope, the cyst was seperated with electric coagulation hook and blunt head suction, and the cyst pediele was closed with titanium clipping or ultrasonic knife. Intraoperative characters were taken into consideration to determine the resection range. Results A total of 37 （37/72, 51.4% ） patients were diagnosed as thymic cyst by chest CT scanning, among which group diameter 〉 3 em and group diameter ~〈 3 cm were 31 cases （31/44,70.5%） and 6 cases （6/28,21.4%） , respectively （X2 = 16. 464, P = 0. 000）. The diagnosis of thymic cyst by chest CT scanning for patients with clear cyst fluid and patients with sticky cyst fluid were 67.9% （19/28） and 21.4% （3/14） , respectively （X2 = 8. 066, P = 0. 005 ）. There were 71 cases of VATS operations and 1 case （ 1.4% ） of conversion to open surgery due to pleural adhesions, including 31 cases of cyst resection and thymeetomy, 21 cases of cyst resection and partial thymeetomy, 10 cases of extended thymeetomy, and l0 eases （~f cyst resection. No serious postoperative complications were observed. The mean operative time was （113. 1 ＋43.5） min. The median intraoperative blood loss was 50.0 ml （range, 5 -250 ml）. Follow-ups were conducted in 60 patients, and the median follow-up time was 47 months （range, 24 -150 months）. No local recurrence was seen in all the patients. Conclusions The diameter of thymic cysts and cyst fluid properties are important influence factors for diagnostic accuracy of chest CT scanning. VATS resection of thymie cysts is a safe and efficacious minimally invasive procedure. Symptoms, imaging diagnosis, operative exploration and complete resection should be taken into consideration to determine the resection range.