胸腔镜胸腺切除术：21 世纪的技术要点。
Thoracoscopic thymectomy: technical pearls to a 21st century approach.
机构信息
Division of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, USA.
出版信息
J Thorac Dis. 2013 Apr;5(2):129-34. doi: 10.3978/j.issn.2072-1439.2013.03.05.
PURPOSE
Thoracoscopic approaches to thymectomy have increased as imaging and instrumentation have advanced. Indications for the thoracoscopic approach are evolving. We reviewed our experience in the transition from sternotomy to thoracoscopy and have gleaned technical points to aid in performing thymectomy.
METHODS
The experience during the transition of sternotomy to thoracoscopy was reviewed.
RESULTS
THE FOLLOWING COMPONENTS HAVE BEEN OBSERVED TO BE ADVANTAGEOUS: (I) initial patient positioning is crucial; (II) thoracoscopy provides improved visualization (a separate camera setup can facilitate visualization of the left phrenic nerve); (III) CO2 aids in dissection; (IV) electrocautery and harmonic scalpel aid in dissection and hemostasis; (V) circumferential dissection identifies anatomic boundaries; (VI) endoscopic ligation of innominate vein branches is adequate; and (VII) minimal access techniques impart a shorter convalescence. In our transition, the length of stay has decreased from 4.3±2.9 to 2.3±1.2 days (P=0.0217).
CONCLUSIONS
We are routinely able to employ this thoracoscopic approach for complete removal of thymic tissue in patients with myasthenia gravis and those with small (<3 cm) thymic masses. A standard approach to dissection in thoracoscopic thymectomy streamlines the procedure and enables safe resection.
目的
随着影像学和仪器设备的进步，胸腔镜胸腺切除术的应用越来越多。胸腔镜手术的适应证也在不断发展。我们回顾了从胸骨切开术到胸腔镜手术的转变经验，并总结了一些技术要点，以帮助完成胸腺切除术。
方法
回顾了从胸骨切开术到胸腔镜手术的转变经验。
结果
以下几点被认为是有利的：（i）初始患者体位至关重要；（ii）胸腔镜提供了更好的可视化效果（单独的摄像设备可以方便地观察左膈神经）；（iii）CO2 有助于解剖；（iv）电烙和超声刀有助于解剖和止血；（v）环形解剖确定解剖边界；（vi）内镜结扎无名静脉分支即可；（vii）微创技术带来更短的恢复期。在我们的转变过程中，住院时间从 4.3±2.9 天缩短至 2.3±1.2 天（P=0.0217）。
结论
我们能够常规采用这种胸腔镜方法，为重症肌无力患者和直径小于 3cm 的胸腺肿瘤患者完全切除胸腺组织。胸腔镜胸腺切除术的标准解剖方法简化了手术过程，实现了安全切除。
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