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剑突下与肋间入路胸腔镜胸腺扩大切除术的临床体会 被引量:10

A clinical analysis on subxiphoid and intercostal video-assisted thoracoscopic extended thymectomy
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摘要 目的探讨经剑突下入路与肋间入路胸腔镜(video-assisted thoracoscopic surgery, VATS)胸腺扩大切除术的特点。方法回顾性分析2015年1月至2018年12月徐州市中心医院胸外科VATS胸腺扩大切除术的病例资料113例,依据术式不同分为经肋间多孔VATS (multiple-port VATS,MVATS)组46例(肋间MVATS组)、剑突下MVATS组40例与剑突下单孔VATS (uniportal VATS,UVATS)组27例(剑突下UVATS组)。比较手术相关参数的差异。结果肋间入路组5例、剑突下入路组7例术前合并重症肌无力(myasthenia gravis, MG)。患者无中转开胸手术或死亡。剑突下UVATS组3例中转剑突下MVATS。肋间MVATS组与剑突下MVATS组、剑突下UVATS组比较,手术时间短[(64.0±15.1) min比(71.4±18.1) min比(87.4±18.7) min, P<0.05],胸腔引流时间短[(1.5±0.7) d比(2.3±1.1) d比(2.9±1.3) d, P< 0.05]、胸腔引流量少[(131.4±66.5) ml比(169.9±110.6) ml比(231.5±111.9) ml, P< 0.05]、术后住院时间短[(1.9±1.1) d比(3.1±2.0) d比(3.7±2.8) d, P< 0.05],而术后1 d视觉模拟评分高[(4.2±1.3)分比(3.7±1.1)分比(3.5±1.2)分,P< 0.05]。剑突下UVATS组2例术后出现MG危象。CT提示剑突下MVATS组1例、剑突下UVATS组5例术后前纵隔脂肪影残留。结论剑突下入路VATS胸腺扩大切除术是可行的,但与肋间入路MVATS比较无显著优势。 Objective To explore the clinical characteristics of video-assisted thoracoscopic (VATS) extended thymectomy via subxiphoid and intercostal approaches. Methods Clinical data of consecutive VATS extended thymectomy performed between Jan. 2015 and Dec. 2018 in Department of Thoracic Surgery of Xuzhou Central Hospital was retrospectively analyzed. The patients were divided into intercostal multiple VATS (MVATS) group, subxiphoid MVATS group and subxiphoid uniportal VATS (UVATS) group. The operation-related parameters were compared respectively among the groups. Results There were 5 cases in the intercostal group and 7 cases in the subxiphoid groups suffered from myasthenia gravies (MG) before surgery. There was no short-term mortality, or conversion to thoracotomy. Three patients in subxiphoid UVATS group converted to subxiphoid MVATS. Besides, as compared with the subxiphoid MVATS and UVATS group, the patients of intercostal MVATS group revealed shorter operation time [(64.0±15.1) min vs (71.4±18.1) min vs (87.4±18.7) min, P< 0.05], shorter chest tube drainage [(1.5±0.7) d vs (2.3±1.1) d vs (2.9±1.3) d, P< 0.05], smaller drainage volume [(131.4±66.5) ml vs (169.9±110.6) ml vs (231.5±111.9) ml, P<0.05], shorter postoperative stay [(1.9±1.1) d vs (3.1±2.0) d vs (3.7±2.8) d, P< 0.05], but higher pain score on the first postoperative day [(4.2±1.3) vs (3.7±1.1) vs (3.5±1.2), P<0.05]. In addition, subxiphoid UVATS group reported two cases of MG crisis after surgery. Besides, incomplete resection of anterior mediastinal fat tissue was found in 1 case in the subxiphoid MVATS group and 5 cases in the UVATS group, as shown by computered tomography after surgery. Conclusions Subxiphoid VATS extended thymectomy is feasible, but it does not indicate significant advantages as compared with intercostal MVATS approach.
作者 张淼 武文斌 杨敦鹏 刘冬 张辉 胡正群 Zhang Miao;Wu Wenbin;Yang Dunpeng;Liu Dong;Zhang Hui;Hu Zhengqun(Department of Thoracic Surgery, Xuzhou Central Hospital, Xuzhou 221009, China)
出处 《中华腔镜外科杂志(电子版)》 2019年第3期166-170,共5页 Chinese Journal of Laparoscopic Surgery(Electronic Edition)
关键词 剑突下 单孔 胸腔镜 胸腺切除术 Subxiphoid Uniportal Video-assisted thoracic surgery Thymectomy
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  • 1易俊,董国华,许飚,李好,景华.达芬奇-S外科手术辅助系统在普胸外科的应用[J].医学研究生学报,2011,24(7):696-699. 被引量:23
  • 2方文涛,陈文虎,陈岗,何卫中,蒋勇.胸腺上皮肿瘤的外科治疗-204例临床病理分析[J].肿瘤,2005,25(4):377-380. 被引量:15
  • 3马山,于磊,张云峰.胸腔镜胸腺切除术治疗重症肌无力[J].中华胸心血管外科杂志,2006,22(6):365-366. 被引量:27
  • 4Yasushi Sakamaki,Tetsuo Kido,Motoaki Yasukawa.Alternative choices of total and partial thymectomy in video-assisted resection of noninvasive thymomas[J]. Surgical Endoscopy . 2008 (5)
  • 5Savitt MA,,Gao G,Furnary AP,et al.Application of robotic-assisted techniques to the surgical evaluation and treatment of the anterior mediastinum. The Annals of Thoracic Surgery . 2005
  • 6Zahid I,Sharifa S,Routledgeb T,et al.Video-assisted thoracoscopic surgery or transsternal thymectomy in the treatment of myasthenia gravis?. Interact CardioVasc Thorac Surg . 2011
  • 7Vannucci J,Pecoriello R,Ragusa M,et al.Multiple pleuropericardial implants of thymoma after videothoracoscopic resection. Interact CardioVasc Thorac Surg . 2010
  • 8Toker A,Erus S,Ozkan B,et al.Does a relationship exist between the number of thoracoscopic thymectomies performed and the learning curve for thoracoscopic resection of thymoma in patients with myasthenia gravis?. Interact CardioVasc Thorac Surg . 2011
  • 9Odaka M,Akiba T,Yabe M,et al.Unilateral thoracoscopic subtotal thymectomy for the treatment of stage I and II thymoma. European Journal of Cardio Thoracic Surgery . 2010
  • 10Rea F,Marulli G,Bortolotti L,et al.Experience with the"da Vinci"robotic system for thymectomy in patients with myasthenia gravis:report of33cases. The Annals of Thoracic Surgery . 2006

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