Departments of General Thoracic Surgery and Clinical Research, National Hospital Organization Kyushu Medical Center, Fukuoka City, Japan.
Ann Thorac Surg. 2011 Dec;92(6):2000-5. doi: 10.1016/j.athoracsur.2011.07.054.
Video-assisted thoracoscopic extended thymectomy (VATET) for a thymoma larger than 5 cm in size is still technically difficult.
Thirty-five patients with clinical Masaoka stage I thymoma underwent an original VATET procedure between November 1998 and December 2009.
All patients successfully underwent VATET, and none required conversion to a median sternotomy. Two patients also underwent partial resection of the lung and pericardium. Although there were no perioperative deaths, 3 patients experienced minor complications. The average tumor size was 5.2 cm. Fifteen tumors were larger than 5 cm. Pathologically, 15 were Masaoka stage I, 19 were stage II, and one was stage III. There were no significant differences in the tumor size between stages I and II. There were two type A, eight type AB, 15 type B1, five type B2, and three type B3 tumors and two thymic carcinomas. Twenty tumors were located in the right side of the body, five were in the middle, and ten were on the left. There were no differences in tumor size or pathologic stage according to location. There were also no differences in pathologic stage according to tumor size. The average follow-up period was 65 months. One patient showed recurrence to the bilateral lung 3.5 years after the procedure. After resection, this patient was free of disease 5 years after the first procedure. There has been no recurrence in any of the other patients.
Our original VATET procedure may be indicated for patients with clinical Masaoka stages I and II thymoma and in those with tumors larger than 5 cm.
对于大于 5 厘米的胸腺瘤，胸腔镜辅助下扩大胸腺切除术（VATET）在技术上仍然具有挑战性。
1998 年 11 月至 2009 年 12 月，35 例临床 Masaoka Ⅰ期胸腺瘤患者接受了原创的 VATET 手术。
所有患者均成功接受 VATET 手术，无一例需要转为正中开胸。另有 2 例患者还行了部分肺和心包切除术。虽然无围手术期死亡，但 3 例患者出现轻微并发症。平均肿瘤大小为 5.2 厘米，其中 15 例肿瘤大于 5 厘米。病理上，15 例为 Masaoka Ⅰ期，19 例为Ⅱ期，1 例为Ⅲ期。Ⅰ期和Ⅱ期肿瘤大小无显著差异。有 2 个 A 型，8 个 AB 型，15 个 B1 型，5 个 B2 型和 3 个 B3 型肿瘤和 2 个胸腺癌。20 个肿瘤位于右侧，5 个位于中间，10 个位于左侧。肿瘤大小或病理分期与位置无关。病理分期也与肿瘤大小无关。平均随访时间为 65 个月。1 例患者术后 3.5 年出现双侧肺复发。再次切除后，该患者在首次手术后 5 年无病生存。其他患者均无复发。
我们原创的 VATET 手术可能适用于临床 Masaoka Ⅰ期和Ⅱ期胸腺瘤患者，以及肿瘤大于 5 厘米的患者。
