胸腔镜手术治疗肋骨骨纤维异常增殖症的可行性研究(附15例报告)

Clinical observation of thoracoscopic costectomy in treatment of costal fibrous dysplasia(15 cases)

目的探讨胸腔镜微创手术治疗肋骨骨纤维异常增殖症的安全性、疗效及优势。方法回顾性分析2013年2月-2020年8月中南大学湘雅二医院胸外科收治的15例肋骨骨纤维异常增殖症患者的临床资料,患者均采用胸腔镜微创手术方法治疗。其中,男7例,女8例,年龄16~52岁,平均(36.7±12.6)岁。病变位于左侧6例,右侧9例;共17根肋骨发生病变,位于第4肋1例,第5肋5例,第6肋5例,第7肋3例,第8肋2例,第9肋1例。无合并奥尔布赖特综合征患者。手术均由同一组高年资医师完成。采用胸腔镜单操作孔进行手术(2孔,一孔为观察孔,一孔为操作孔),胸腔镜下定位病变肋骨,在胸腔内操作切除。结果15例患者均顺利完成手术。手术时间45~72 min,平均(61.0±10.5)min。术后病理均为肋骨骨纤维异常增殖症。术后住院时间3~5 d,平均(3.0±1.0)d。术后疼痛评分1~5分,平均(3.3±1.2)分。术中术后无严重并发症。术后随访12~36个月,平均(24.5±6.2)个月,所有患者未见复发。结论胸腔镜手术治疗肋骨骨纤维异常增殖症安全、可靠,创伤小,疗效满意,值得推广应用。

Objective To evaluate the safety,efficacy and advantage of thoracoscopic costectomy in treatment of fibrous dysplasia.Methods The clinical data of 15 patients with costal fibrous dysplasia underwent thoracoscopic costectomy from February 2013 to August 2020 were retrospectively analyzed.There were 7 male and 8 female.The average age of the patients was(36.7±12.6)years old(range,16~52 years).The costal fibrous dysplasia were located on the left in 6 cases and on the right in 9 cases.The costal fibrous dysplasia were located in the fourth rib in 1 case,the fifth rib in 5 cases,the sixth rib in 5 cases,the seventh rib in 3 cases,the eighth rib in 2 cases,and the ninth rib in 1 case(17 ribs involved).All operations were performed by the same group of senior doctors.Thoracoscopic operation(2 holes,one for observation and the other for operation)was used to locate the lesion and the whole operation was completed by this method.Results All the operations of the 15 cases were completed successfully and the postoperative pathology was coastal fibrous dysplasia.The operation time was 45~72 min,with an average of(61.0±10.5)min.The postoperative hospital stay was 3~5 days,with an average of(3.0±1.0)days.The postoperative pain score was 1~5 points,with an average of(3.3±1.2)points.There were no serious complications.All the patients were followed up for 12~36 months,with an average of(24.5±6.2)months,no recurrence was found.Conclusion Thoracoscopic costectomy in treatment of costal fibrous dysplasia is safe and effective.The procedure has the advantage in aspects of less invasive,pain and convenient.It is worthy of extending clinical application.