Di Crescenzo Vincenzo Giuseppe, Napolitano Filomena, Panico Claudio, Di Crescenzo Rosa Maria, Zeppa Pio, Vatrella Alessandro, Laperuta Paolo
Department of Medicine and Surgery, Thoracic Surgery Unit, University of Salerno, Italy.
Department of Medicine and Surgery, Pathology Unit, Federico II University of Naples, Italy.
Int J Surg Case Rep. 2017;39:19-24. doi: 10.1016/j.ijscr.2017.07.028. Epub 2017 Jul 22.
Thymectomy is the main treatment for thymoma and patients with myasthenia gravis (MG). The traditional approach is through a median sternotomy, but, recently, thymectomy through minimally invasive approaches is increasingly performed. Our purpose is an analysis and discussion of the clinical presentation, the diagnostic procedures and the surgical technique. We also consider post-operative complications and results, over a period of 5 years (May 2011-June 2016), in thymic masses admitted in our Thoracic Surgery Unit.
We analyzed 8 patients who underwent surgical treatment for thymic masses over a period of 5 years. 6 patients (75%) had thymoma, 2 patients (25%) had thymic carcinomas. 2 patients with thymoma (33%) had myasthenia gravis. We performed a complete surgical resection with median sternotomy as standard approach.
One patient (12%) died in the postoperative period. The histological study revealed 6 (75%) thymoma and 2 (25%) thymic carcinomas. Post-operative morbidity occurred in 2 patients (25%) and were: pneumonia in 1 case (12%), atrial fibrillation and pleural effusion in 2 patients (25%). One patient with thymoma type A recurred at skeletal muscle 2-years after surgery.
Thymic malignancies are rare tumors. Surgical resection is the main treatment, but a multimodal approach is useful for many patients. Radical thymectomy is completed removing all the soft tissue in the anterior mediastinum between the two phrenic nerves and this is the most important factor in controlling myasthenia and influencing survival in patients with thymoma. Open (median sternotomy) approach has been the standard approach for thymectomy for the better visualization of the anatomical structures. Actually, video-assisted thoracoscopic surgery (VATS) thymectomy and robotic video-assisted thoracoscopic (R-VATS) approach versus open surgery has an equal if not superior oncological efficacy, better perioperative complications and survival outcomes.
胸腺切除术是胸腺瘤和重症肌无力（MG）患者的主要治疗方法。传统方法是通过正中胸骨切开术，但近年来，越来越多地采用微创方法进行胸腺切除术。我们的目的是分析和讨论临床表现、诊断程序和手术技术。我们还考虑了在5年期间（2011年5月至2016年6月），我们胸外科收治的胸腺肿物患者的术后并发症及结果。
我们分析了5年期间接受胸腺肿物手术治疗的8例患者。6例（75%）患有胸腺瘤，2例（25%）患有胸腺癌。2例胸腺瘤患者（33%）患有重症肌无力。我们采用正中胸骨切开术作为标准方法进行了完整的手术切除。
1例患者（12%）术后死亡。组织学研究显示6例（75%）为胸腺瘤，2例（25%）为胸腺癌。2例患者（25%）发生术后并发症，分别为：1例（12%）发生肺炎，2例（25%）发生心房颤动和胸腔积液。1例A型胸腺瘤患者术后2年骨骼肌复发。
胸腺恶性肿瘤是罕见肿瘤。手术切除是主要治疗方法，但多模式方法对许多患者有用。根治性胸腺切除术是指切除双侧膈神经之间前纵隔的所有软组织，这是控制重症肌无力和影响胸腺瘤患者生存的最重要因素。开放（正中胸骨切开术）方法一直是胸腺切除术的标准方法，以便更好地观察解剖结构。实际上，电视辅助胸腔镜手术（VATS）胸腺切除术和机器人电视辅助胸腔镜（R-VATS）方法与开放手术相比，即使在肿瘤学疗效上不更优，至少也是相当的，且围手术期并发症更少，生存结果更好。
