摘要
目的探讨单操作孔电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)在纵隔肿瘤切除术的临床应用价值。方法 2013年12月~2016年6月采用单操作孔胸腔镜手术治疗55例纵隔肿瘤,腋中线第7肋间置入胸腔镜作为观察孔,在腋中线与腋前线之间第4肋间做一个长3~4 cm横行切口作为操作孔,经此操作孔完成手术,术后观察孔置入胸腔闭式引流管。结果单操作孔VATS 50例,3例因瘤体较大,加用辅助小切口完成手术,2例因分离肺动脉分支时发生出血,在腔镜下无法完成止血而中转开胸。50例单操作孔VATS手术时间(100±46)min,术中出血量(85±38)ml,术后胸管引流量(450±80)ml,术后胸引管拔出时间(3.0±1.6)d,术后住院时间(6.2±1.5)d。术后肌无力危象1例,气胸2例,胸腔积液3例,均对症处理后好转。55例术后随访2~24个月,(11.2±7.3)月,无肿瘤复发。结论单操作孔电视胸腔镜下纵隔肿瘤切除术安全、有效,切口美观,值得在临床上推广。
Objective To explore the clinical value of single utility port video-assisted thoracoscopic surgery（VATS） for mediastinal tumor. Methods A retrospective analysis was performed on clinical data of 55 patients with mediastinal tumor who received surgical treatment with single utility port video-assisted thoracoscopic surgery in this department from December 2013 to June2016. Routinely,the surgery was conducted by intraoperatively inserting the thoracoscope via an incision at the seventh intercostals space on the midaxillary line as the observation hole,and making a 3-4 cm transverse incision at the fourth intercostals space between the midaxillary line and the anterior axillary line as the operation hole. Postoperatively,the observation hole served as the passage for closed thoracic drainage tube. Results Among the 55 patients,50 received total thoracoscopic surgery. In 3 cases with relatively large tumor,the surgery was conducted with additional assisted small incisions. Thoracotomy was carried out in another 2 cases due to bleeding when separating pulmonary artery branch and difficult hemostasis under thoracoscopy. The surgery duration was（100 ± 46）min,the intraoperative blood loss was（85 ± 38） ml,the postoperative chest drainage volume was（450 ± 80） ml,the postoperative time to chest tube withdrawal was（3. 0 ± 1. 6） d,and the postoperative duration of hospital stay was（6. 2 ± 1. 5） d in the 50 cases of VATS. All the patients recovered well. Postoperatively,there were 1 case of myasthenic crisis,2 cases of pneumothorax and 3 cases of pleural effusion,all of which were improved with symptomatic treatment. All the 55 cases were followed up for 2-24 months（mean,11. 2 ± 7. 3 months） and there were no tumor recurrences. Conclusion Single utility port VATS of mediastinal tumor resection has advantages in safety,efficacy,and cosmetic outcomes,being worthy of further clinical application.
出处
《中国微创外科杂志》
CSCD
北大核心
2017年第11期1028-1029,1034,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
单操作孔
电视胸腔镜手术
纵隔肿瘤
Single utility port
Video-assisted thoracoscopic surgery
Mediastinal tumor
