Shintani Yasushi, Funaki Soichiro, Nakagiri Tomoyuki, Inoue Masayoshi, Sawabata Noriyoshi, Minami Masato, Kadota Yoshihisa, Okumura Meinoshin
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan.
Interact Cardiovasc Thorac Surg. 2013 Apr;16(4):441-4. doi: 10.1093/icvts/ivs543. Epub 2013 Jan 3.
Although video-assisted thoracoscopic surgery (VATS) is widely used for the resection of a mediastinal mass, it is converted to an open resection in some patients with a mature teratoma because of dense adhesions. We reviewed cases with a mature teratoma removed by VATS and investigated the indications for that procedure for this tumour.
We retrospectively investigated 15 patients with a benign mediastinal mature teratoma who underwent a thoracoscopic procedure.
The mean tumour diameter was 5.3 cm (range 3.2-8.5). The mean operative time was 188 min (78-430), and intraoperative blood loss was 138 ml (10-450). Thoracoscopic resection was completed in all except 3 patients with larger tumours, which presented the most difficult problems with dissection. Each of those 3 had severe preoperative chest pain and a tumour larger than 5.5 cm. No mortality or postoperative complications were recorded, except for postoperative chylothorax. Tumour recurrence did not develop in any patient during the mean follow-up period of 4.6 years.
For selected patients with a mediastinal teratoma, VATS may be considered standard care, as most are benign. In contrast, an open approach may be more appropriate for patients with a large tumour or preoperative symptoms.
尽管电视辅助胸腔镜手术（VATS）广泛应用于纵隔肿物切除，但一些成熟畸胎瘤患者因粘连致密，手术需转为开胸切除。我们回顾了通过VATS切除成熟畸胎瘤的病例，并探讨了该手术方式治疗此肿瘤的适应证。
我们回顾性研究了15例行胸腔镜手术的良性纵隔成熟畸胎瘤患者。
肿瘤平均直径5.3 cm（范围3.2 - 8.5 cm）。平均手术时间188分钟（78 - 430分钟），术中失血138毫升（10 - 450毫升）。除3例肿瘤较大、解剖难度最大的患者外，其余患者均完成胸腔镜切除。这3例患者术前均有严重胸痛，肿瘤直径均大于5.5 cm。除术后乳糜胸外，无死亡病例及术后并发症记录。在平均4.6年的随访期内，无患者出现肿瘤复发。
对于部分纵隔畸胎瘤患者，VATS可作为标准治疗方式，因为大多数为良性。相比之下，对于肿瘤较大或有术前症状的患者，开胸手术可能更为合适。
