经左胸入路电视胸腔镜胸腺切除术

目的 探讨经左胸入路电视胸腔镜胸腺切除的可行性、适应证和操作要点.方法 2004年2月至2009年2月,经左胸入路电视胸腔镜胸腺切除手术23例中男12例,女11例;平均年龄(47.7±15.3)岁.病变最大径(6.1±2.0) mm.6例伴肌无力症状.结果 手术顺利,无严重并发症及围手术期死亡病例.单纯胸腺切除术17例,胸腺扩大切除术6例.病变均匀增生1例,位于胸腺左上极3例,胸腺左下极19例.术后病理证实胸腺瘤14例,胸腺囊肿3例,侵袭性胸腺瘤、胸腺癌各2例,胸腺增生、胸腺畸胎瘤各1例.手术(115.3±21.2)min,术中出血(86.7±68.3)ml,无术中或术后输血病例.因肿瘤侵犯周围器官中转开胸4例.术后轻微并发症2例.随访(22.7±21.6)个月,均未见肿瘤复发.6例肌无力症状均明显好转.结论 经左胸入路电视胸腔镜胸腺切除手术安全、可行,是右胸手术的很好补充.

Left side approach for video-assisted thoracoscopic thymectomy

Objective To evaluate the feasibility and indication of left side approach video-assisted thoracoecopic thymectomy,and to summarize main point of manipulation.Methods Between Feb 2004 and Feb 2009,23 patients(12 men,11 women,median age 47.7yeare,range from 20 to 85 years),underwent left side approach video-assisted thoracoscopic thymectomy.The operation were under general anesthesia with single lung ventilation.Patients were placed right lateral decubitus position.Three ports were made.The entire hemithorax was carefully examined,then mediastinal pleura was incised,the thymus was blunt dissected from inferior horn extending to superior horns.The thymic venous was clipped.Results The types of procedures included simply thymectomy in 17 patients and extending thymectomy in 6.There were no operative deaths or serious complications.Four cases were converted to open thoracotomy.The average operating time was 115 minutes(range from 85 to 140 minutes).The average blood loss was 86 ml (range from 20 to 200 ml) and there was no blood transfusion required.All patients were well during followed up period.Conclusion Left side approach video-assisted thoracoscopic thymectomy was a safe procedure and could be a alternative procedure for right side approach.