胸腔镜手术治疗儿童胸腺瘤的临床研究

Clinical application of thoracoscopic surgery in the treatment of pediatric thymoma

目的探讨胸腔镜切除儿童胸腺瘤的安全性及效果。方法回顾性分析2016年1月至2019年12月收治的6例胸腺瘤患儿的临床资料。其中,男5例,女1例;年龄(10.1±2.7)岁;其中5例合并眼肌型重症肌无力。所有患儿术前CT检查均提示肿瘤包膜完整,未见明显侵犯周围组织,大小在2.3~5.1 cm。6例患儿均行胸腔镜下右侧胸腔入路胸腺瘤切除术。结果全部6例患儿均痊愈出院。手术时间为(52.5±17.5)min,出血量为(6±4)ml。术后未发生伤口及胸腔内感染,未出现术后肌无力危象。患儿于术后3~5 d出院,平均4 d。6例患儿术后病理检查均证实为胸腺瘤,按照WHO胸腺肿瘤国际肿瘤学分类A型3例,AB型1例,B1型2例;分期均为Ⅰ期。6例随访时间为(25±23)个月,无复发病例。结论胸腔镜手术治疗儿童胸腺瘤安全、可行,合并重症肌无力的胸腺瘤患儿需行包括手术治疗在内的综合治理。

Objective To explore the safety and effect of video-assisted thoracoscopic resection of pediatric thymoma.Methods From January 2016 to December 2019,a total of 6 children with thymoma were recruited.There were 5 boys and 1 girl with an age range of(10.1±2.7)years.Five of them were associated with ocular myasthenia gravis.Preoperative computed tomography(CT)indicated that tumor envelope remained intact and there was no obvious invasion of surrounding tissues.Tumor size was 2.3-5.1 cm.All of them underwent right thoracoscopic thymomectomy.Results All 6 cases were cured.Operative duration was(52.5±17.5)min and volume of blood loss(6±4)ml.No wound or intrathoracic infection occurred and there was no postoperative crisis of myasthenia crisis.They were discharged at(4±1)days postoperatively.Postoperative pathological examination confirmed thymoma.According to the WHO International classification of thymic tumors,the clinical types were A(n=3),AB(n=1)and B1(n=2).And all of them belonged to stage I.During a follow-up period of(25±23)months,there was no recurrence.Conclusions Thoracoscopic resection is both safe and feasible for pediatric thymoma.And comprehensive managements(including surgery)are required for thymoma complicated with myasthenia gravis.