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目的 探讨胸腔镜手术治疗小儿纵膈肿物的可行性、安全性、有效性.总结胸腔镜手术治疗小儿纵膈肿物经验.方法 回顾性分析2006年7月至2013年9月,应用胸腔镜手术治疗小儿纵膈肿物27例的临床资料.本组术前均行增强CT检查,肿物直径4.5～12 cm,平均(6.7±1.7) cm.术前CT诊断畸胎瘤10例,支气管源性囊肿6例,食管源性囊肿7例,神经母细胞瘤4例.全部患儿实施胸腔镜肿物切除术,术中病理冰冻切片检查确诊.结果 全部患儿顺利完成胸腔镜纵膈肿物切除术,无中转开放手术患儿,肿物完整切除.手术时间90～220 min,平均(137.9±33.3) min.估计出血量5～80 ml,无输血患儿.术后当天进水,第1天进食;住院时间3～7 d,平均(4.6±1.2)d.术后无并发症发生,无围手术期死亡患儿.术后病理检查报告,切除完全,边缘无肿瘤组织残留.良性畸胎瘤肿瘤10例、支气管源性囊肿7例、食管源性囊肿7例,节神经母细胞瘤4例,与CT诊断基本符合.术后随访4个月～7年,平均(37.0±21.7)个月,患儿健康生存,无肿瘤复发.结论 选择适宜的纵膈肿物患儿应用胸腔镜手术治疗是安全、可行的.术者胸腔镜操作技术熟练、纵膈肿瘤切除经验丰富及可靠影像学技术支持,是手术安全、成功的保障.根据术中情况必要时应及时中转开胸,不强求胸腔镜切除.术前全面准确的评估病情可降低中转开胸率.恶性肿瘤手术例数尚少、随访时间尚短,胸腔镜手术应谨慎.“,”Objective To explore the feasibility,safety and efficacy of thoracoscopically resecting mediastinal tumors in children.Methods A total of 27 children with mediastinal tumors between July 2006 and September 2013 were recruited to undergo thoracoscopic surgery.The tumors were cystic or solid with a mean diameter of 6.7 ± 1.7 (4.5-12)crn.And 19 of them were symptomatic.The most common site was upper mediastinum.Results All mediastinal tumors were completely excised.There was no conversion into thoracotomy.The mean operative duration was (137.9 ± 33.3)(90-220) min.There was no operative complication with a minimal amount of blood loss.Neither pneumothorax nor hydrothorax occurred.With a smooth recovery,the mean postoperative hospital stay was 4.6 ± 1.2 (3-7) days.During a mean follow-up period of 37.0 ± 21.7 (4-84) months,neither complication nor recurrence occurred.Conclusions Throcoscopic excision of mediastinal tumors is both feasible and safe in children.And this mini-invasive approach should be considered as a first-line therapeutic option.Proper preoperative case selection may prevent a conversion into thoracotomy due to huge mass and adhesions.