经剑突下及肋弓下切口胸腔镜胸腺切除术的临床分析_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 孟庆军 , 孔繁义 , 宋翔

沧州市中心医院胸外科（河北沧州 061000）;

Corresponding author：

孟庆军, Email: dreamaaa@126.com

Keywords：

经剑突下及肋弓下切口; 胸腔镜; 胸腺肿瘤; 重症肌无力

DOI：

10.7507/1007-4848.201707013

Video：

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目的探讨经剑突下及肋弓下切口胸腔镜胸腺切除的可行性、安全性、适应证及操作要点。方法回顾性分析沧州市中心医院胸外科 2015 年 1 月至 2017 年 7 月经剑突下及双侧肋弓下胸腔镜胸腺切除术 85 例患者的临床资料，其中男 34 例、女 51 例，年龄 42～70（34.0±11.0）岁，合并重症肌无力者 6 例。结果所有入组患者手术顺利，无围手术期并发症。无重症肌无力患者行全胸腺切除术，合并重症肌无力患者行全胸腺心包前纵隔脂肪切除术。手术时间 60～120（85.0±18.0） h，出血量 20～50 ml，胸腔引流管留置时间 1～3（2.0±0.7） d，术后住院时间 5～10（7.0±1.5）d。术后病理：胸腺瘤 45 例，胸腺癌 6 例，胸腺囊肿 32 例，胸腺脂肪瘤 1 例，胸腺增生 1 例。术后随访时间 1～12 个月。根据美国重症肌无力协会（MGFA）疗效判断标准，合并重症肌无力（6 例）术后完全缓解 1 例（16.7%），药物缓解 5 例（83.3%）。所有患者术后至 2017 年 7 月无肿瘤复发。结论经剑突下及肋弓下切口胸腔镜胸腺切除术安全可行，具有创伤小、疼痛轻、术后恢复快等优点，可以作为治疗部分胸腺疾病和重症肌无力的有效手术方式。

Citation： 孟庆军, 孔繁义, 宋翔. 经剑突下及肋弓下切口胸腔镜胸腺切除术的临床分析. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(5): 449-452. doi: 10.7507/1007-4848.201707013 Copy

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6.	蒋耀光, 王如文, 赵云平, 等. 重症肌无力胸腺切除 236 例分析. 中国胸心血管外科临床杂志, 2004, 11(1): 32-34．.
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10.	刘会平, 李剑锋, 吴怡成, 等. 电视胸腔镜胸腺扩大切除治疗重症肌无力 107 例临床分析. 中华外科杂志, 2005, 43(10): 625-627.
11.	Jaretzki A 3^rd, Barohn RJ, Ernstoff RM, et al. Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Ann Thorac Surg, 2000, 70(1): 327-334.
12.	Pompeo E, Nofroni I, Iavicoli N, et al. Thoracoscopic completion thymectomy in refractory nonthymomatous myasthenia. Ann Thorac Surg, 2000, 70(3): 918-923.
13.	Ruckert JC, Walter M, Muller JM. Pulmonary function after thoracoscopic thymectomy versus median sternotomy for myasthenia gravis. Ann Thorac Surg, 2000, 70(5): 1656-1661．.
14.	Odaka M, Akiba T, Yabe M, et al. Unilateral thoracoscopic subtotal thymectomy for the treatment of stageⅠand Ⅱ thymoma. Eur J Cardiothorac Surg, 2010, 37(4): 824-826.
15.	魏立, 陈明耀, 务森, 等. 双侧胸腔镜下治疗胸腺疾病的临床观察.中华医学杂志, 2010, 90(19): 1326-1328.
16.	Suda T, Ashikari S, Tochii S, et al. Single-incision subxiphoid approach for bilateral metastasectomy. Ann Thorac Surg, 2014, 97(2): 718-719.
17.	Liu CC, Wang BY, Shih CS, et al. Subxiphoid single-incision thoracoscopic left upper lobectomy. J Thorac Cardiovasc Surg, 2014, 148(6): 3250-3251.
18.	Gonzalez-Rivas D. Recent advances in uniportal video-assisted thoracoscopic surgery. Chin J Cancer Res, 2015, 27(1): 90-93.
19.	Wang BY, Chang YC, Chang YC, et al. Thoracoscopic surgery via a single-incision subxiphoid approach is associated with less postoperative pain than single-incision transthoracic or threeincision transthoracic approaches for spontaneous pneumothorax. J Thorac Dis, 2016, 8(Suppl 3): S272-S278.

1. 段德溥, 主编. 现代纵隔外科学. 北京: 人民军医出版社, 2001. 210-220.
2. 范诚诚, 冯勤付, 毛友生, 等. 111 例 Ⅲ 期胸腺瘤治疗结果分析. 中华放射肿瘤学杂志, 2012, 21(6): 513-517.
3. Savcenko M, Gretchen K, Syma L, et al. Video-assisted thymectomy for myasthenia gravis: an update of a single institution experience. Eur J Cardiothoracic surg, 2002, 22(6): 978-983.
4. Zhao J, Wang J, Han Y, et al. Subxiphoid and subcostal arch thoracoscopic extended thymectomy: a safe and feasible minimally invasive procedure for selective stage Ⅲ thymomas. J Thorac Dis, 2016, 8(suppl 3): s258-s264.
5. Besinger UA, Toyka KV, Homberg M, et al. Myasthenia gravis longI- term correlation of binding and bungartooxin blocking antibodies against acetylcholine receptor with changes in disease severity. Neurology, 1983, 33(10): 1316-1321.
6. 蒋耀光, 王如文, 赵云平, 等. 重症肌无力胸腺切除 236 例分析. 中国胸心血管外科临床杂志, 2004, 11(1): 32-34．.
7. Cooper JD, AL-Jilaihawa AN, Pearson FG, et al. An improved technique to facilitate transcervical thymectomy for myasthenia gravis. Ann Thorac Surg, 1988, 45(3): 242-247．.
8. 于磊, 王天佑, 马山, 等. 胸腔镜与胸骨劈开胸腺切除术治疗重症肌无力的中远期疗效比较. 中华医学杂志, 2007, 87(45): 3171-3173.
9. Mineo TC, Pompeo E, Lerut T, et al. Thoracoscopic thymectomy in autoimmune myasthenia: results of the left-sided approach. Ann Thorac Surg, 2000, 69: 1537-1541.
10. 刘会平, 李剑锋, 吴怡成, 等. 电视胸腔镜胸腺扩大切除治疗重症肌无力 107 例临床分析. 中华外科杂志, 2005, 43(10): 625-627.
11. Jaretzki A 3^rd, Barohn RJ, Ernstoff RM, et al. Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Ann Thorac Surg, 2000, 70(1): 327-334.
12. Pompeo E, Nofroni I, Iavicoli N, et al. Thoracoscopic completion thymectomy in refractory nonthymomatous myasthenia. Ann Thorac Surg, 2000, 70(3): 918-923.
13. Ruckert JC, Walter M, Muller JM. Pulmonary function after thoracoscopic thymectomy versus median sternotomy for myasthenia gravis. Ann Thorac Surg, 2000, 70(5): 1656-1661．.
14. Odaka M, Akiba T, Yabe M, et al. Unilateral thoracoscopic subtotal thymectomy for the treatment of stageⅠand Ⅱ thymoma. Eur J Cardiothorac Surg, 2010, 37(4): 824-826.
15. 魏立, 陈明耀, 务森, 等. 双侧胸腔镜下治疗胸腺疾病的临床观察.中华医学杂志, 2010, 90(19): 1326-1328.
16. Suda T, Ashikari S, Tochii S, et al. Single-incision subxiphoid approach for bilateral metastasectomy. Ann Thorac Surg, 2014, 97(2): 718-719.
17. Liu CC, Wang BY, Shih CS, et al. Subxiphoid single-incision thoracoscopic left upper lobectomy. J Thorac Cardiovasc Surg, 2014, 148(6): 3250-3251.
18. Gonzalez-Rivas D. Recent advances in uniportal video-assisted thoracoscopic surgery. Chin J Cancer Res, 2015, 27(1): 90-93.
19. Wang BY, Chang YC, Chang YC, et al. Thoracoscopic surgery via a single-incision subxiphoid approach is associated with less postoperative pain than single-incision transthoracic or threeincision transthoracic approaches for spontaneous pneumothorax. J Thorac Dis, 2016, 8(Suppl 3): S272-S278.

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