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  • 黄鑫,吴亮,陈健,杨晨露,蒋雷.剑突下单孔胸腔镜治疗前纵隔肿瘤的回顾性临床研究[J].第二军医大学学报,2019,40(8):843-846    [点击复制]
  • HUANG Xin,WU Liang,CHEN Jian,YANG Chen-lu,JIANG Lei.Subxiphoid uniportal video-assisted thoracoscopic surgery for anterior mediastinal tumor: a retrospective clinical study[J].Acad J Sec Mil Med Univ,2019,40(8):843-846   [点击复制]
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剑突下单孔胸腔镜治疗前纵隔肿瘤的回顾性临床研究
黄鑫1,吴亮2,陈健2,杨晨露2,蒋雷2*
0
(1. 西南交通大学附属成都市第三人民医院胸外科, 成都 610031;
2. 同济大学附属上海市肺科医院胸外科, 上海 200433
*通信作者)
摘要:
目的 探讨经剑突下单孔胸腔镜治疗前纵隔肿瘤的可行性及临床效果。方法 回顾性分析2014年10月至2018年8月同济大学附属上海市肺科医院开展的所有38例经剑突下单孔胸腔镜前纵隔肿瘤切除术患者的临床资料,男性20例、女性18例,平均年龄为(57.8±14.8)岁,前纵隔肿瘤直径为(2.8±1.7)cm。手术方法为剑突下行纵行单切口(长度约4 cm),在胸腔镜下进行手术。结果 38例患者均顺利完成剑突下单孔胸腔镜手术,无中转开胸,无围手术期死亡,除1例患者因术后重症肌无力症状加重而依靠呼吸机维持1周外,无其他显著并发症发生。手术时间为1~4 h,平均手术时间为(1.9±0.8)h;术中失血量为10~400 mL,平均术中失血量为(87.5±68.7)mL,手术当日引流量为50~650 mL,平均引流量为(237.4±176.4)mL;术后住院时间为1~19 d,平均术后住院时间为(4.1±2.9)d。术后病理诊断为A型、B2型、B3型胸腺瘤各1例,AB型胸腺瘤5例,胸腺鳞癌1例,胸腺增生6例,胸腺囊肿16例,单纯胸腺及脂肪6例,支气管囊肿1例。术后1、3、6个月疼痛视觉模拟评分分别为3.8±2.2、1.5±1.4、0.8±0.6。结论 对于早期胸腺瘤、其他良性前纵隔肿瘤以及部分早期的前纵隔恶性肿瘤,经剑突下单孔胸腔镜手术是一种安全、有效、可行的手术方式,且能有效避免肋间神经损伤导致的顽固性切口疼痛。
关键词:  剑突下入路  单孔胸腔镜手术  前纵隔肿瘤  手术后疼痛
DOI:10.16781/j.0258-879x.2019.08.0843
投稿时间:2019-02-06修订日期:2019-05-19
基金项目:
Subxiphoid uniportal video-assisted thoracoscopic surgery for anterior mediastinal tumor: a retrospective clinical study
HUANG Xin1,WU Liang2,CHEN Jian2,YANG Chen-lu2,JIANG Lei2*
(1. Department of Thoracic Surgery, Third People's Hospital of Chengdu, Southwest Jiaotong University, Chengdu 610031, Sichuan, China;
2. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
*Corresponding author)
Abstract:
Objective To explore the feasibility and clinical effect of subxiphoid uniportal video-assisted thoracoscopic surgery in the treatment of the anterior mediastinal tumors. Methods The clinical data of 38 patients, who underwent subxiphoid uniportal video-assisted thoracoscopic surgery for anterior mediastinal tumor in Shanghai Pulmonary Hospital of Tongji University from Oct. 2014 to Aug. 2018, were retrospectively analyzed. Among them, 20 were males and 18 were females, the average age was (57.8±14.8) years, and the average diameter of anterior mediastinal tumors was (2.8±1.7) cm. The surgery was performed under video-assisted thoracoscope through an about 4 cm subxiphoid longitudinal incision. Results All the 38 cases of subxiphoid uniportal video-assisted thoracoscopic surgery were performed successfully without conversion to thoracotomy or perioperative death. Except for one patient who received mechanical ventilatory support for 1 week because of worsened myasthenia gravis symptoms, there were no other complications. The operative time, volume of bleeding, volume of drainage on the operation day and hospital stay after surgery were 1-4 (1.9±0.8) h, 10-400 (87.5±68.7) mL, 50-650 (237.4±176.4) mL and 1-19 (4.1±2.9) d, respectively. Postoperative pathology showed 1 case of type A thymoma, 1 case of type B2 thymoma, 1 case of type B3 thymoma, 5 cases of type AB thymoma, 1 case of thymic squamous carcinoma, 6 cases of thymic hyperplasia, 16 cases of thymic cyst, 6 cases of simple thymus and fat and 1 case of bronchial cyst. The visual analogue scale scores on 1, 3 and 6 months after surgery were 3.8±2.2, 1.5±1.4 and 0.8±0.6, respectively. Conclusion Subxiphoid uniportal video-assisted thoracoscopic surgery is a safe, efficient, satisfactory procedure for early stage thymoma, benign anterior mediastinal tumors and some early stage anterior mediastinal malignant tumors, and it can effectively avert the intractable incision pain caused by intercostal nerve injury.
Key words:  subxiphoid approach  uniportal video-assisted thoracoscopic surgery  anterior mediastinal neoplasms  postoperative pain