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目的评价电视胸腔镜手术(VATS)治疗后纵隔肿瘤的安全性、有效性,探讨影响手术疗效的危险因素。方法回顾性分析北京大学人民医院胸外科2001年5月至2009年7月收治的59例后纵隔肿瘤患者经VATS治疗的临床资料,男36例,女23例;年龄6~73岁,平均年龄40.6岁;肿瘤平均最大直径4.86 cm。所有患者均施行VATS后纵隔肿瘤切除术。手术在全身麻醉下施行,通过3个套管切口完成,如需中转开胸,则延长前侧切口至6~10 cm。打开纵隔胸膜后,沿包膜外剥除肿瘤,蒂部的血管神经分别进行处理。采用logistic多因素回归分析影响手术疗效的危险因素。结果所有患者手术顺利。手术时间45~300 min(125.80±57.40 min),术中出血量10~1 000ml(168.10±157.70 ml),术后胸腔引流时间1~10 d(2.50±1.74 d),术后住院时间2~14 d(5.24±2.24 d)。中转开胸手术6例,中转开胸率10.2%。术后病理诊断:神经源性肿瘤46例,囊肿10例,畸胎瘤2例,脂肪瘤1例。术后随访51例,随访时间7~108个月(55.0±24.0个月);失访8例(13.6%)。无复发或因肿瘤导致死亡患者。logistic多因素分析结果表明:肿瘤最大直径≥6 cm是使手术时间延长(OR=1.932,P=0.004)、术中出血量增加(OR=2.267,P=0.002)、中转开胸率增加(OR=3.123,P=0.004)和术后并发症发生率增高(OR=1.778,P=0.013)的独立危险因素。结论 VATS治疗后纵隔肿瘤安全、可行,肿瘤最大直径≥6cm是增加手术难度和手术风险的重要因素。
Objective To evaluate the safety and effectiveness of mediastinum tumor after video-assisted thoracoscopic surgery (VATS) and to explore the risk factors influencing the curative effect of surgery. Methods The clinical data of 59 patients with posterior mediastinal tumors treated by VATS from May 2001 to July 2009 in Peking University People’s Hospital were retrospectively analyzed. There were 36 males and 23 females with a mean age of 6 to 73 years 40.6 years old; average tumor diameter of 4.86 cm. All patients underwent VATS after mediastinal tumor resection. Surgery under general anesthesia, through the three cannulated incision to complete, if the need for transit thoracotomy, then extend the anterior incision to 6 ~ 10 cm. Open the mediastinal pleura, the tumor along the outer capsule, the pedicle of the vascular nerves were processed. Logistic regression analysis was used to analyze the risk factors influencing the curative effect. Results All patients underwent surgery successfully. The operative time was 45 ~ 300 min (125.80 ± 57.40 min), intraoperative blood loss was 10 ~ 1 000 ml (168.10 ± 157.70 ml), postoperative chest drainage time was 1 ~ 10 days (2.50 ± 1.74 days), postoperative hospital stay was 2 ~ 14 d (5.24 ± 2.24 d). Transcatheter thoracotomy in 6 cases, transfer thoracotomy rate of 10.2%. Postoperative pathological diagnosis: 46 cases of neurogenic tumors, cysts in 10 cases, 2 cases of teratoma, lipoma in 1 case. Fifty-one patients were followed up for 7-108 months (55.0 ± 24.0 months) and 8 patients (13.6%) were lost to follow-up. No recurrence or death due to tumor patients. The results of logistic multivariate analysis showed that the maximum diameter of tumor≥6 cm was associated with prolonged operation time (OR = 1.932, P = 0.004), increased blood loss during operation (OR = 2.267, P = 0.002) = 3.123, P = 0.004) and the incidence of postoperative complications (OR = 1.778, P = 0.013). Conclusion The mediastinal tumor after VATS is safe and feasible. The maximum diameter of tumor is more than 6cm, which is an important factor to increase the operation difficulty and operation risk.