论文部分内容阅读
目的探讨3D模式下电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)治疗纵隔肿瘤的安全性和有效性。方法 2013年7月~2015年7月采用3D-VATS治疗62例纵隔肿瘤,按照术前CT肿瘤位置设计观察孔及操作孔,术中根据情况可将操作孔与观察孔互换。若肿瘤>5 cm,与大血管关系紧密,或与周围粘连不易显露,可采用胸腔镜辅助小切口(video-assisted minithoracotomy,VAMT)进行手术。结果 58例3D-VATS顺利完成手术;3例因瘤体直径约6 cm,行VAMT;1例因肿瘤侵犯左无名静脉中转开胸手术。2例术中损伤膈神经致膈肌抬高,术后3个月恢复;2例肺不张,抗炎、雾化、咳痰后好转。均未出现术中及术后近期30 d死亡病例。术后病理:胸腺瘤31例,胸腺增生16例,胸腺癌5例,支气管囊肿1例,胸腺囊肿1例,淋巴细胞增生2例,畸胎瘤3例,神经源性肿瘤2例,胸膜脂肪瘤l例。62例随访1~24个月,中位随访时间12个月,所有良性肿瘤均无复发,胸腺癌复发1例。结论 3D模式下VATS治疗纵隔肿瘤是一种新的选择方式,临床效果安全、可行。
Objective To investigate the safety and efficacy of video-assisted thoracoscopic surgery (VATS) in the treatment of mediastinal tumors in 3D mode. Methods From July 2013 to July 2015, 62 cases of mediastinal tumors were treated with 3D-VATS. Observation holes and operation holes were designed according to the location of tumor before operation. The operation holes and observation holes were interchangeable according to the situation. If the tumor> 5 cm, closely related to the large blood vessels, or with the surrounding adhesions is not easy to reveal, can be used thoracoscopic video-assisted minithoracotomy (VAMT) for surgery. Results Fifty-eight cases of 3D-VATS successfully completed the operation. Three patients underwent VAMT because of the diameter of the tumor being about 6 cm. One patient underwent left-sided thoracotomy because of tumor invasion. 2 cases of intraoperative phrenic nerve injury caused by diaphragm elevation, 3 months after recovery; 2 cases of atelectasis, anti-inflammatory, atomization, sputum improved. No intraoperative and postoperative short-term 30 d deaths. Postoperative pathology: thymoma in 31 cases, thymus hyperplasia in 16 cases, thymus carcinoma in 5 cases, bronchial cyst in 1 case, thymus cyst in 1 case, lymphocytic hyperplasia in 2 cases, teratoma in 3 cases, neurogenic tumor in 2 cases, pleural fat Tumor l cases. Sixty-two patients were followed up for 1 to 24 months. The median follow-up time was 12 months. There was no recurrence in all benign tumors and 1 case of recurrent thymus cancer. Conclusion 3DS VATS treatment of mediastinal tumors is a new choice, the clinical effect is safe and feasible.