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目的:总结我科76例电视胸腔镜辅助下纵隔肿瘤切除手术的经验,探讨电视胸腔镜手术在纵隔肿瘤切除中的临床应用价值。方法:本组76例,男47例,女29例,年龄16～70岁,平均42.5岁,其中确诊胸腺瘤14例,胸腺囊肿9例,皮样囊肿5例,神经源性肿瘤14例,食管囊肿8例,气管支气管囊肿5例,心包囊肿9例,淋巴管样囊肿5例,浸润性胸腺瘤3例,其他3例。均采用全麻双腔插管,健侧卧位或患侧抬高30～45°位,健侧单肺通气。胸腔镜置于腋前线至腋后线的第6～8肋间套管,操作套管2～3个,如术中探查肿瘤直径过大,或因粘连严重显露困难等原因,可辅助小切口完成肿物切除。结果:41例经胸腔镜完成肿物切除,28例附加5～8cm小切口完成手术,4例中转开胸手术,3例行活检,全组病人术后恢复好,无围手术期死亡发生。结论:电视胸腔镜手术适合于部分纵隔肿瘤的微创手术治疗,安全有效,对大多数纵隔良性肿瘤、特别是大部分囊性病变及后纵隔神经源性肿瘤的切除较传统的开胸手术具有明显优势。
Objective: To summarize the experience of 76 cases of video-assisted thoracoscopic assisted resection of mediastinum tumor in our department and to discuss the clinical value of video-assisted thoracoscopic surgery in the resection of mediastinal tumor. Methods: The group of 76 patients, 47 males and 29 females, aged 16 to 70 years old, with an average of 42.5 years, of which 14 cases were diagnosed as thymoma, thymus cyst in 9 cases, dermoid cysts in 5 cases, neurogenic tumors in 14 cases, 8 cases of esophageal cyst, 5 cases of tracheobronchial cyst, 9 cases of pericardial cyst, 5 cases of lymphatic cyst, 3 cases of invasive thymoma, the other 3 cases. All anesthesia dual lumen intubation, contralateral or ipsilateral lateral elevation 30 ~ 45 °, contralateral single lung ventilation. Thoracoscopy placed axillary line to the axillary line 6 ~ 8 intercostal cannula, the operation of the casing 2 to 3, such as intraoperative exploration of tumor diameter is too large, or due to serious adhesions revealed and other reasons, can help small incision Complete the tumor removal. Results: 41 cases underwent thoracoscopic resection of the tumor, 28 cases were treated with small incision of 5 ~ 8cm, 4 cases underwent thoracotomy and 3 cases underwent biopsy. All the patients recovered well and no perioperative death occurred. Conclusion: Video-assisted thoracoscopic surgery is suitable for minimally invasive surgical treatment of some mediastinal tumors, which is safe and effective. It has the advantages over the traditional thoracotomy in the treatment of most mediastinal benign tumors, especially most cystic lesions and posterior mediastinal neurogenic tumors obvious advantage.