摘要
目的探讨经剑突下入路胸腔镜胸腺切除的解剖基础与临床效果分析。方法回顾性分析2018年6月—2019年12月蚌埠医学院第一附属医院胸外科收治的33例经剑突下入路胸腔镜胸腺切除患者的临床资料。其中,男15例、女18例,年龄(53.94±13.37)岁。患者术前均诊断为胸腺肿物。术后病理诊断:胸腺瘤12例、胸腺癌1例、畸胎瘤3例、胸腺增生1例、胸腺囊肿16例。观察手术路径的安全性及术野显露情况;记录术后引流量及引流管放置时间、术后住院时间,术后24 h进行疼痛视觉模拟评分(VAS),观察术后并发症发生情况。结果本组患者均顺利完成胸腔镜胸腺完整切除术,无中转开放手术。其中合并有肺楔形切除2例,合并心包部分切除2例。剑突下入路手术路径安全,暴露良好,术中胸腺周围的解剖结构显示清晰,能完整显示左右两侧心包膈神经、上腔静脉、前方胸骨、后方心包及左侧无名静脉、上方甲状腺下极等胸腺毗邻结构。术后引流量(429.24±308.34)mL;引流时间(3.61±1.56)d;住院时间(5.88±3.43)d;术后24 h疼痛VAS评分为(1.82±0.68)分。围术期无死亡病例,1例重症肌无力患者术后症状加重,经机械通气、药物等治疗后痊愈;1例患者术后出现低钠血症,补钠后痊愈。结论经剑突下入路胸腔镜胸腺切除的解剖路径暴露良好,具有较好的手术安全性和临床效果,更好地体现了微创理念。
Objective To investigate the anatomical basis and clinical effect of thoracoscopic thymectomy below the xiphoid.Methods The clinical data of 33 patients[15 males and 18 females,with average age of(53.94±13.37)years]who underwent thoracoscopic thymectomy below the xiphoid from June 2018 to December 2019 at the Department of Thoracic Surgery of the First Affiliated Hospital of Bengbu Medical College were retrospectively analyzed.All patients were diagnosed with thymic tumors before the operation.Postoperative pathological diagnosis included 12 cases of thymoma,1 case of thymic carcinoma,3 cases of teratoma,1 case of thymic hyperplasia,and 16 cases of thymic cyst.The anatomical basis and surgical scope of the procedure were recorded and analyzed.The postoperative drainage volume and drainage time,postoperative hospitalization days,visual analogue scale(VAS)pain score at 24 h after surgery,and postoperative complications were recorded.Results Thymectomy was successfully performed in all patients without conversion to thoracotomy.At the same time,there were two cases of pulmonary wedge resection and two cases of partial pericardiectomy.It is safe to operate through the subxiphoid approach.The visual field was well exposed.The anatomic structure around the thymus is clear,and the adjacent structure of the thymus is completely displayed.The phrenic nerve of the pericardium and superior vena cava,sternum,pericardium and left innominate vein,and the inferior pole of the thyroid are clearly exposed.The postoperative drainage was(429.24±308.34)mL.The postoperative drainage time was(3.61±1.56)days.The postoperative hospital stay was(5.88±3.43)days.The VAS score of pain 24 h after operation was(1.82±0.68)points.No death was recorded during the perioperative period.One patient recovered from myasthenia gravis after mechanical ventilation and medication.One patient had hyponatremia after operation and recovered after sodium supplementation.Conclusions The anatomical approach of thoracoscopic thymectomy below the xiphoid has good surgical safety and clinical effect and is minimally invasive.
作者
张雷
贡会源
王彪
李小军
唐震
宋超
Zhang Lei;Gong Huiyuan;Wang Biao;Li Xiaojun;Tang Zhen;Song Chao(Department of Thoracic Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China)
出处
《中华解剖与临床杂志》
2020年第6期657-661,共5页
Chinese Journal of Anatomy and Clinics
基金
蚌埠医学院第一附属医院高新技术项目(2017155)。
关键词
胸腺切除术
胸腔镜
剑突下
胸腺
解剖学
微创
Thymectomy
Thoracoscopes
Below the xiphoid
Thymus
Clinical anatomy
Minimally invasiv
