纵隔支气管源性囊肿的诊断和电视胸腔镜手术治疗

The diagnosis and video-assisted thoracic surgery for mediastinal bronchogenic cysts

目的探讨纵隔支气管源性囊肿的临床特点,胸腔镜手术治疗价值和要点。方法 2001 年 4 月至 2016 年 4 月,我科连续收治 112 例纵隔支气管源性囊肿患者,其中男 53 例、女 59 例,年龄 4~75 (45.6 ± 15.0)岁。根据病变位置将患者分为两组:前纵隔组,47 例,病变于前纵隔;中后纵隔组,65 例(病变位于中纵隔 35 例、后纵隔 30 例)。囊肿直径 0.5~22.0(3.50±2.33)cm,平扫 CT 值 0~67(35.5±15.3)Hu;均先行胸腔镜手术切除病灶。结果中后纵隔组中 CT 值≤20 Hu 诊断支气管源性囊肿比例显著高于其他患者(61.5% vs. 13.1%,χ2=17.675,P<0.001)。胸腔镜手术 111 例,中转开胸 1 例。前纵隔组:囊肿+胸腺切除术(n=45),合并肌无力者行胸腺扩大切除术(n=2);中后纵隔组:囊肿切除术(n=65)。手术时间 40~360(104.5±43.1)min,术中出血量 5~600(57.9±88.9)mL。多因素 logistic 回归分析显示囊肿直径≥5 cm 是手术时间延长和出血量增多的危险因素。术中并发症和不完整切除发生率分别为 3.6%和 6.3%,囊肿与纵隔重要结构致密粘连或融合是上述两者的主要原因;成功随访 99 例(88.4%),中位随访时间 42(12~191)个月,均未见复发。结论胸腔镜手术治疗纵隔支气管源性囊肿安全有效,具有微创优势,囊肿直径≥5 cm 增加手术难度,建议尽早手术。

Objective To emphasize the important role of video-assisted thoracoscopic surgery (VATS) in treatment of mediastinal bronchogenic cysts (MBCs). Methods We retrospectively reviewed the clinical data of 112 patients (53 males and 59 females) of mediastinal bronchogenic cysts who underwent VATS in our institution between April 2001 and Aprial 2016. Median age was 4-75 (45.6±15.0) years. All patients underwent chest CT preoperatively. The patients were divided into two groups: an anterior mediastinum group, 47 patients;a middle and posterior mediastinum group, 65 patients including 35 patients in the middle mediastinum, 30 patients in the posterior mediastinum. The average diameter was 0.5-22.0 (3.50±2.33) cm. The average CT attenuation was 0-67 (35.5±15.3) Hu on unenhanced CT. We began each operation with the VATS technique. Results The CT diagnostic accuracy for group middle and posterior mediastinum with CT value W 20 Hu was higher than others (61.5% vs. 13.1%,X^2=17.675, P<0.001). A total of 111 patients underwent VATS, only one patient converted to open thoracotomy. Cyst resection and thymectomy were conducted in 45 patients, cyst resection and extended thymectomy were conducted in 2 patients in the anterior mediastinum group. Simply cyst resection were performed in the middle and posterior mediastinum group (w=65). The average operative time was 40-360 (104.5±43.1) min. The average intraoperative blood loss was 5-600 (57.9±88.9) mL. The intraoperative complication rate was 3.6% and the incomplete resection rate was 6.3%. The main reason for these was severe adhesion between the cyst and mediastinal structure. No serious postoperative complication was found. Follow-up was done in 99 patients, and the mean follow-up time was 42 (12-191) months. There was no local recurrence. Conclusion VATS resection of MBCs is a safe and efficacious procedure, and minimally invasive and surgical resection should be performed as early as possible for MBCs.