胸腔镜与开放胸腺切除术治疗较大胸腺瘤围手术期的效果对比

Comparison of Thoracoscopic Versus Open Thymectomy in Treatment of Large Thymoma During Perioperative Period

目的评价胸腔镜治疗直径≥50 mm胸腺瘤的可行性。方法回顾性分析121例行胸腔镜下和开放胸腺切除术治疗MasaokaⅠ~Ⅲ期胸腺瘤患者的临床病理资料,对比两种手术方式在治疗直径≥50 mm胸腺瘤围手术期的效果。结果121例胸腺瘤患者中大瘤体组术中出血量多,中转开胸例数多,术后引流管留存时间长、引流量较多,大瘤体组与小瘤体组差异有统计学意义(P<0.05);早期组大瘤体患者中有26例行腔镜手术,与开胸手术相比其术中出血量更少,术后并发症发生率低,术后引流管留存时间短、引流量少、住院时间短,两组差异有统计学意义(P<0.05);接受腔镜手术的早期患者中,大瘤体组和小瘤体组各项观察指标差异均无统计学意义(P>0.05);MasaokaⅢ期患者中腔镜组耗时长,术中出血多,术后并发症发生率高、引流量多,腔镜组和开放组差异有统计学意义(P<0.05)。结论胸腔镜治疗MasaokaⅠ~Ⅱ期直径≥50 mm的胸腺瘤具有微创性和术后恢复快等优点,具有较好的临床可行性;对于MasaokaⅢ期患者,腔镜手术难度大,围手术期效果较差。

Objective To evaluate the feasibility of video-assisted thoracoscopic surgery in the treatment of thymoma with≥50 mm in diameter.Methods We retrospectively analyzed the clinical and pathological data of 121 cases of MasaokaⅠ-Ⅲthymoma treated with VATS and open thymectomy from January 2012 to December 2017,and compared the effect of two surgical methods on thymoma with≥50 mm in diameter during perioperative period.Results Among the 121 thymoma patients,those with large tumor diameter had more intraoperative blood loss,more cases converted to open surgery,the drainage tube retention time was longer,postoperative drainage was more,and there was statistically significant difference between large tumor group and small tumor group(P<0.05).Among early-stage patients with large tumor diameter,26 patients who underwent thoracoscopic surgery had less intraoperative blood loss,lower postoperative complication rate,shorter drainage tube retention time,less postoperative drainage and shorter hospital stay than those who underwent thoracotomy(P<0.05).Among the early-stage patients who underwent thoracoscopic surgery,there were no statistically significant difference between the large and small tumor groups(P>0.05).Among the MasaokaⅢpatients,the VATS group had longer operation time,more intraoperative blood loss,higher postoperative complication rate and more postoperative drainage,and there was statistically significant difference between VATS group and open surgery group(P<0.05).Conclusion Thoracoscopic surgery for MasaokaⅠ-Ⅱtumor with≥50 mm in diameter could be more minimally invasive,more quickly postoperative recovery and better clinical feasibility.But for MasaokaⅢpatients,thoracoscopic surgery is difficult for operator and the curative effect in perioperative period is poor.