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目的探讨完全电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)在切除纵隔肿瘤,尤其是大体积和侵袭性纵隔肿瘤中的临床价值。方法回顾性分析了我科2011年1月至2014年12月经VATS行纵隔肿瘤切除手术患者113例,男性51例,女性62例。年龄9~78岁(中位年龄50岁),肿瘤最大径线值1.5~13 cm(中位径线值4 cm)。记录围术期各项观察指标并行统计学分析。结果 113例纵隔肿瘤均在VATS下完成,术中出血量10~800 m L(中位出血量100 m L),术后住院时间2~18 d(中位术后住院时间5 d),手术时间40~330 min(中位手术时间90 min)。统计分析指出直径>6 cm的纵隔肿瘤共28例(占24.8%),围术期无死亡和相关并发症发生,术后随访未见肿瘤复发。相对于直径<6 cm的肿瘤,直径>6 cm的纵隔肿瘤手术时间延长(P<0.001),术中出血量增加(P<0.001),但术后住院时间未见明显延长。4例侵袭性纵隔肿瘤(3例恶性胸腺瘤和1例畸胎瘤)行VATS,围术期无死亡病例和并发症发生,术后随访1例复发。结论 VATS广泛应用于纵隔肿瘤的切除,同时大体积以及侵袭性纵隔肿瘤不是VATS的禁忌。在一定条件下,VATS对大体积以及侵袭性纵隔肿瘤的治疗可以达到和传统开放手术相似的治疗效果,同时能够降低手术创伤,减轻术后疼痛,缩短患者住院时间以及减少术后并发症,且安全、有效、经济。
Objective To investigate the clinical value of video-assisted thoracoscopic surgery (VATS) in the resection of mediastinal tumors, especially in large volume and invasive mediastinal tumors. Methods A retrospective analysis of our department from January 2011 to December 2014 by VATS line of mediastinal tumor resection in 113 patients, 51 males and 62 females. Aged 9 to 78 years (median age 50 years), the largest diameter of the tumor was 1.5-13 cm (median diameter 4 cm). The perioperative records of all indicators were statistically analyzed. Results All 113 mediastinal tumors were completed under VATS. The intraoperative blood loss was 10 ~ 800 m L (the median bleeding volume was 100 m L), the postoperative hospital stay was 2 ~ 18 days (median postoperative hospital stay was 5 days), the operation Time 40 ~ 330 min (median operation time 90 min). Statistical analysis indicated that there were 28 cases (24.8%) of mediastinal tumors> 6 cm in diameter. There was no death and related complications during perioperative period. No tumor recurrence was found after follow-up. Operative time was longer (P <0.001) for mediastinal tumors> 6 cm in diameter than in tumors <6 cm in diameter, with an increase in intraoperative bleeding (P <0.001), but there was no significant increase in postoperative hospital stay. VATS was performed in 4 cases of invasive mediastinal tumors (3 cases of malignant thymoma and 1 case of teratoma). No deaths and complications occurred during the perioperative period. One case was followed up for recurrence. Conclusion VATS is widely used in the resection of mediastinal tumors, while large volumes and invasive mediastinal tumors are not contraindicated in VATS. Under certain conditions, VATS treatment of large and invasive mediastinal tumors can achieve similar treatment effects as conventional open surgery while reducing surgical trauma, reducing postoperative pain, shortening patient stay and reducing postoperative complications, and Safe, effective and economical.