Agasthian Thirugnanam
National Cancer Center, 11 Hospital Drive, Singapore 169610, Singapore.
Asian Cardiovasc Thorac Ann. 2011 Jun;19(3-4):225-7. doi: 10.1177/0218492311407977.
Although video-assisted thoracic surgery can be used for well-encapsulated thymomas, its role in invasive thymomas remains controversial. Between 1998 and 2009, 77 patients aged 22-76 years underwent thymomectomy by video-assisted thoracic surgery. Tumors <5 cm without major invasion on preoperative computed tomography were selected. There were 13 invasive thymomas (Masaoka stage III and IV). A modified dissection technique was employed to prevent breaching the tumor capsule and risking tumor seedling. Limited resection of the phrenic nerve, pericardium, perithymic fat, and a wedge of lung was performed en bloc with the tumor. The mean duration of surgery was 138 min. Hospital stay was 3.6 days. Eleven patients had associated myasthenia gravis. There was 1 case of wound infection and no operative mortality. The mean size of the thymomas was 34 mm (range, 23-55 mm). All patients had adjuvant radiotherapy. During follow-up of 4.9 years (range, 1-10 years), there was one local recurrence. With the modified video-assisted thoracic surgery technique, selected invasive thymomas detected during surgery can be removed safely without resorting to sternotomy.
虽然电视辅助胸腔镜手术可用于包膜完整的胸腺瘤，但它在侵袭性胸腺瘤中的作用仍存在争议。1998年至2009年期间，77例年龄在22至76岁之间的患者接受了电视辅助胸腔镜手术切除胸腺瘤。选择术前计算机断层扫描显示肿瘤<5 cm且无明显侵袭的患者。其中有13例侵袭性胸腺瘤（Masaoka III期和IV期）。采用改良的解剖技术以防止突破肿瘤包膜并避免肿瘤播散风险。将膈神经、心包、胸腺周围脂肪和楔形肺组织与肿瘤一并整块切除。手术平均时长为138分钟。住院时间为3.6天。11例患者伴有重症肌无力。有1例伤口感染，无手术死亡病例。胸腺瘤的平均大小为34 mm（范围为23至55 mm）。所有患者均接受了辅助放疗。在4.9年（范围为1至10年）的随访期间，有1例局部复发。采用改良的电视辅助胸腔镜手术技术，术中发现的部分侵袭性胸腺瘤无需开胸即可安全切除。
