胸腔镜剑突下小切口治疗双侧胸腺瘤的临床效果

程少先 徐文礼 艾瑞华 张耀晴 廖永德

[摘要]目的 比較常规开胸手术、胸腔镜（VATS）经肋间手术与VATS剑突下小切口手术治疗早期胸腺瘤的临床效果，探讨VATS剑突下小切口手术治疗双侧胸腺瘤的可行性及优越性。方法 选取我院2014年1月～2017年6月符合Masaoka分期法Ⅰ～Ⅱ期诊断标准的62例胸腺瘤患者作为研究对象，根据手术方式不同进行分组。16例患者采用VATS经剑突下小切口手术，24例患者采用VATS经肋间手术，22例患者采用传统前正中切口胸骨劈开手术。比较三组患者的手术时间、术中出血量、引流时间、住院天数、疼痛程度、抗菌时间、并发症发生率、患者满意度等情况。结果 VATS经剑突下组的手术时间、术后引流时间、抗菌时间和术后住院天数短于VATS经肋间组与胸骨劈开组，术中出血量少于VATS经肋间组与胸骨劈开组，差异有统计学意义（P<0.05）；三组患者的并发症发生率（6.25%、12.50%、18.18%）、满意度（81%、59%、42%）比较，差异有统计学意义（P<0.05），VATS经剑突下组优势明显。随访期间，三组患者均无复发和转移。结论 VATS剑突下小切口手术治疗双侧胸腺瘤能够减少手术创伤，降低并发症发生率，减轻患者痛苦，缩短患者住院时间，值得临床推广应用。

[关键词]胸腔镜；经剑突下；胸腺瘤；胸骨正中切口

[中图分类号] R736.3 [文献标识码] A [文章编号] 1674-4721（2018）5（a）-0008-05

[Abstract]Objective To compare the clinical effects of routine thoracotomy，VATS intercostal surgery and VATS subxiphoid small incision in the treatment of early thymomas，and to investigate the feasibility and superiority of VATS subxiphoid small incision surgery for bilateral thymomas.Methods A total of 62 patients with thymoma who met the diagnosis criteria of phase Ⅰ-Ⅱ of the Masaoka staging method in our hospital from January 2014 to June 2017 were selected as the study subjects.They were assigned to different groups based on different surgical methods.A total of 16 patients were given VATS subxiphoid small incision surgery，24 patients were given VATS intercostal surgery，and 22 patients were given a traditional frontal and midline incision sternotomy.The surgery time，intraoperative blood loss，drainage time，length of stay，pain degree，antibacterial time，complication rate，and patient satisfaction were compared between the three groups.Results The operative time，postoperative drainage time，antibacterial time and postoperative hospitalization days in VATS subxiphoid group were shorter than those in VATS intercostal group and sternotomy group，the intraoperative blood loss in VATS subxiphoid group was less than that in VATS intercostal group and sternotomy group，with significant difference （P<0.05）.The incidence rate of complications in the three groups was 6.25%，12.50%，18.18%，and satisfaction was 81%，59%，42%，and the differences were statistically significant （P<0.05）.The advantage of VATS subxiphoid group was significant.During the follow-up period，no recurrence or metastasis was observed in all the three groups.Conclusion The VATS subxiphoid small incision in the treatment of bilateral thymoma reduces the surgical trauma，reduces the incidence rate of complications，alleviates the patient′s pain and shortens the hospital stay.It is worthy of clinical promotion and application.

[Key words]Thoracoscopy；Subxiphoid；Thymoma；Midline sternotomy

胸腺瘤（thymoma）是最常见的前上纵隔原发性肿瘤，占成人所有纵隔肿瘤的20%～40%[1]，国外文献显示胸腺瘤在人群中的年发病率为0.15/10万，男女比例为1︰1，发病高峰年龄在40～50岁。胸腺瘤有易复发浸润的特点，临床上常视其为有潜在恶性，早期患者可以通过手术治愈。传统的胸腺瘤切除术采取的是前正中切口胸骨劈开，该方式破坏了胸骨的稳定性，对机体的损伤大，增加了胸骨、纵隔、肺部感染的概率，严重者术中、术后并发呼吸循环障碍，存在较大的风险性，但该术式作为胸腺瘤治疗的金标准目前仍在很多医院应用，尤其是绝大部分基层医院。……