Tagawa Tsutomu, Yamasaki Naoya, Tsuchiya Tomoshi, Miyazaki Takuro, Morino Shigeyuki, Akamine Shinji, Nagayasu Takeshi
Division of Surgical Oncology, Department of Translational Medical Science, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan,
Surg Today. 2014 Dec;44(12):2275-80. doi: 10.1007/s00595-013-0829-5. Epub 2014 Jan 21.
This study was undertaken to investigate the efficacy of a video-assisted thoracoscopic (VATS) approach for stage I and II thymoma through comparisons with the transsternal approach.
The indications for VATS resection were clinical stage I or II thymoma, a tumor less than 50 mm, located within the thymic lobes and separated from the brachiocephalic vein. Data were collected between 1995 and 2007.
Twenty-seven patients underwent total thymectomy (15 by VATS and 12 by the transsternal approach). The mean tumor size was 36.3 (22-50) mm for VATS and 37.6 (15-55) mm for the transsternal group (p = 0.7862). The mean lengths of the operation were 249.8 min and 227.9 min (p = 0.2728), respectively. The mean intraoperative blood loss was significantly lower in VATS, at 92.3 ml, than the 225.1 ml lost in the transsternal group (p = 0.0020). The morbidity rates were 13.3 and 8.3% (p = 0.6812), respectively. There was no mortality in either group. The mean follow-up periods were 109.0 (37-145) months following VATS and 102.0 (44-175) months following the transsternal approach. One stage II patient developed pleural dissemination three years after VATS resection. Other patients survived with no recurrence.
VATS resection of early stage thymoma can be performed with less bleeding and with a comparable prognosis to the transsternal approach. VATS resection should thus be considered as a viable option for treatment.
本研究旨在通过与经胸骨入路进行比较，探讨电视辅助胸腔镜（VATS）入路治疗Ⅰ期和Ⅱ期胸腺瘤的疗效。
VATS切除的适应证为临床Ⅰ期或Ⅱ期胸腺瘤、肿瘤小于50mm、位于胸腺叶内且与头臂静脉分离。收集1995年至2007年的数据。
27例患者接受了全胸腺切除术（15例采用VATS，12例采用经胸骨入路）。VATS组的平均肿瘤大小为36.3（22 - 50）mm，经胸骨入路组为37.6（15 - 55）mm（p = 0.7862）。平均手术时长分别为249.8分钟和227.9分钟（p = 0.2728）。VATS组术中平均失血量显著低于经胸骨入路组，分别为92.3ml和225.1ml（p = 0.0020）。发病率分别为13.3%和8.3%（p = 0.6812）。两组均无死亡病例。VATS切除术后的平均随访时间为109.0（37 - 145）个月，经胸骨入路术后为102.0（44 - 175）个月。1例Ⅱ期患者在VATS切除术后3年出现胸膜播散。其他患者存活且无复发。
VATS切除早期胸腺瘤出血较少，预后与经胸骨入路相当。因此，VATS切除应被视为一种可行的治疗选择。
