摘要
目的探讨完全胸腔镜手术在纵隔肿瘤切除术中的应用。方法完全胸腔镜下行纵隔肿瘤切除术45例。全麻,双腔或单腔插管。根据肿瘤所在的部位不同,体位采用健侧卧位或患侧抬高30°卧位。后纵隔肿瘤镜孔位置位于第7、8肋间腋中线,操作孔在第3、4或5肋间腋前线和腋后线。前纵隔肿瘤镜孔位于第5肋间腋后线,操作孔位于第3肋间以及第5肋间腋前线。手术孔的长度约1.5cm。首先做一镜孔,插入30°腔镜探查,根据肿瘤位置,分别做一主操作孔和一辅助操作孔,3个手术孔成一个三角形。经操作孔分离胸腔内粘连,钝性加锐性分离肿瘤,滋养血管镜下丝线结扎或钛夹夹闭。肿瘤置于标本袋内取出胸腔。结果 45例均在完全胸腔镜下完成纵隔肿瘤切除术,不需要辅助小切口,无中转开胸。手术时间20～230min,平均110.4min。39例术后胸腔闭式引流管放置时间18～94h,平均26.7h;其余6例未放胸腔闭式引流管。术后住院时间1～12d,平均4.5d。无肺炎、肺不张等肺部并发症。术后病理:神经源性肿瘤18例,胸腺瘤12例,畸胎类肿瘤5例,淋巴性肿瘤4例,囊肿4例,脂肪瘤1例,平滑肌瘤1例。30例随访3～23个月,平均11个月,复发1例。结论完全胸腔镜下可以对纵隔肿瘤完成分离、切割、缝合、打结等操作,安全可行,纵隔肿瘤应首选完全胸腔镜手术。
Objective To investigate the value of total thoracoscopy in the treatment of mediastinal tumor. Methods Totally 45 cases of mediastinal tumor that underwent total thoracoscopy in our hospital were enrolled in this study. Under general anesthesia with single-or double-lumen intubation, the operation was performed with the patients lying on the healthy side or supine position with the injured limb raised up by 30°. Post-mediastinally, one trocar was inserted at the 7th or 8th intercostal on the midaxillary line, and the operational hole was set at the 3rd, 4th, or 5th intercostal on the anterior and posterior axillary lines. Anterior mediastinally, one trocar was instered at the 5th intercostal on the posterior axillary line, and the operational holes were located at the 3rd and 5th intercostal on the anterior axillary line. The length of the operation holes was around 1.5 cm. During the operation, after a scope hole was made for exploration by using a 30° endoscope, a major and an auxiliary hole were made according to the location of the tumor, forming a triangle with the scope hole. The adhesive tissues in the mediastinal cavity were then separated, and the tumor was resected and removed after its supplying vessels were ligated or clipped. Results The operation was completed successfully in all of the 45 cases without using auxiliary incision. The mean operation time was 110.4 minutes （ranged from 20 to 230 mintues）. After the surgery, the drainage tube was withdrawn in 18 to 94 h with a mean of 26.7 h in 39 patients;the drainage tube was not placed in other 6 patients. In this series, the postoperative hospital stay was 4.5 day （ranged from 1 to 12 days）; no pneumonia or atelectasis occurred. Postoperative pathological examination showed neurogenic tumor in 18 cases, thymomas in 12 patients, teratoma in 5, lymphoma in 4, cyst in 4, lipoma in 1, and leiomyoma in 1.Conclusion Total thoracoscopy can be the first choice for mediastinal tumors, since we can perform serration, resection, anastomosis, and ligation with the technique leading to same outcomes as open surgery.
出处
《中国微创外科杂志》
CSCD
2010年第6期486-487,共2页
Chinese Journal of Minimally Invasive Surgery
