Berber E, String A, Garland A M, Engle K, Siperstein A
Department of General Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A80, Cleveland, OH 44195 USA.
Surg Endosc. 2000 Jul;14(7):680. doi: 10.1007/s004640000097. Epub 2000 Apr 17.
Rarely, a posterior mediastinal mass may mimic an adrenal tumor on preoperative computed tomography scan. The intraoperative discovery that a mass thought to be associated with the adrenal gland actually is above the diaphragm in the posteroinferior mediastinum poses a challenge for the laparoscopic surgeon. Conversion to a thoracotomy or to videothoracoscopy incurs additional morbidity and risk for the patient.
We describe a technique for the transdiaphragmatic removal of a benign mass from the posterior mediastinum. A posterior mediastinal tumor was detected during a laparoscopic procedure for a suspected right adrenal tumor. Frozen section proved benign, and the mass was resected laparoscopically via transdiaphragmatic access to the posterior mediastinum.
No complications were noted during or after surgery. The patient was ready for discharge from the hospital on postoperative day 1.
Transdiaphragmatic resection was done successfully instead of conversion to a thoracotomy or thoracoscopic procedure for a benign posterior mediastinal tumor found incidentally during laparoscopic surgery for a presumed adrenal lesion. This transdiaphragmatic approach can be applied to selected benign mediastinal masses.
在术前计算机断层扫描中，后纵隔肿块很少会被误诊为肾上腺肿瘤。术中发现，被认为与肾上腺相关的肿块实际上位于后纵隔的膈肌上方，这给腹腔镜外科医生带来了挑战。转为开胸手术或电视胸腔镜手术会给患者带来额外的发病率和风险。
我们描述了一种经膈肌从后纵隔切除良性肿块的技术。在腹腔镜手术中，因怀疑右肾上腺肿瘤而发现了一个后纵隔肿瘤。冰冻切片证实为良性，通过经膈肌进入后纵隔的方式，在腹腔镜下切除了肿块。
手术期间及术后均未发现并发症。患者术后第1天即可准备出院。
对于在腹腔镜手术中偶然发现的、疑似肾上腺病变的良性后纵隔肿瘤，成功实施了经膈肌切除术，而非转为开胸手术或胸腔镜手术。这种经膈肌入路可应用于选定的良性纵隔肿块。
