Souzaki Ryota, Kawakubo Naonori, Miyoshi Kina, Obata Satoshi, Kinoshita Yoshiaki, Takemoto Junkichi, Kohashi Kenichi, Oda Yoshinao, Taguchi Tomoaki
1 Department of Pediatric Surgery, Faculty of Medical Sciences, Reproductive and Developmental Medicine, Kyushu University , Fukuoka, Japan .
2 Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University , Fukuoka, Japan .
J Laparoendosc Adv Surg Tech A. 2018 Nov;28(11):1378-1382. doi: 10.1089/lap.2018.0169. Epub 2018 Jun 19.
Thoracoscopic surgery for pediatric benign tumors is a common procedure. However, a large incision is needed to remove large tumors from the thoracic cavity. And, for intrapulmonary sequestration in lower lobe, it sometimes needs a large incision to ligate the aberrant vessels. A muscle-sparing axillar skin crease incision (MSASCI) has been introduced for thoracic open surgery, resulting in excellent aesthetic outcomes compared with a standard incision. We herein report the utility of this MSASCI technique in thoracoscopic surgery to remove large tumors from the thoracic cavity and to ligate the aberrant vessels in intrapulmonary sequestration in lower lobe.
From 2014 April to 2016 March, we performed the MSASCI technique in thoracoscopic surgeries for 5 children.
Five cases were diagnosed as mediastinal masses (mature teratoma for 1 case, ganglioneuroblastoma for 2 cases, and extrapulmonary sequestration and intrapulmonary sequestration for 1 case each). The age at surgery was 32.0 ± 25.0 months (range 5-58 months). The size of the mediastinal mass was 9 × 5 × 5 cm, 4 × 3 × 3 cm, 5 × 5 × 2.5 cm, and 3 × 2.5 × 2 cm. For 4 other cases, except for the intrapulmonary sequestration case, the mass was resected under thoracoscopic surgery using only three or four 5-mm trocars and the mass was removed from the thoracic cavity using the MSASCI technique. For the intrapulmonary sequestration case, the aberrant vessels were resected under thoracoscopic surgery using only two 5-mm and one 12-mm trocars and the left lower lobectomy was performed using the MSASCI technique. All lesions were resected completely. No cases had surgical complications, none showed recurrence, and all cases demonstrated good cosmetic outcomes.
Performing thoracoscopic surgery using a MSASCI technique is associated with good cosmetic outcome.
小儿良性肿瘤的胸腔镜手术是一种常见的手术方式。然而，要从胸腔中切除大的肿瘤需要做一个大切口。而且，对于下叶肺隔离症，有时需要做大切口来结扎异常血管。一种保留肌肉的腋下皮肤皱襞切口（MSASCI）已被引入用于开胸手术，与标准切口相比，其美容效果极佳。我们在此报告这种MSASCI技术在胸腔镜手术中用于从胸腔切除大肿瘤以及结扎下叶肺隔离症异常血管的效用。
2014年4月至2016年3月，我们在5例儿童的胸腔镜手术中采用了MSASCI技术。
5例被诊断为纵隔肿物（1例成熟畸胎瘤，2例神经节神经母细胞瘤，1例肺外隔离症和1例肺内隔离症）。手术时年龄为32.0±25.0个月（范围5 - 58个月）。纵隔肿物大小分别为9×5×5cm、4×3×3cm、5×5×2.5cm和3×2.5×2cm。除肺内隔离症病例外，其他4例病例仅使用三或四个5毫米套管针在胸腔镜手术下切除肿物，并采用MSASCI技术将肿物从胸腔取出。对于肺内隔离症病例，仅使用两个5毫米和一个12毫米套管针在胸腔镜手术下切除异常血管，并采用MSASCI技术行左下肺叶切除术。所有病变均被完全切除。无手术并发症病例，无复发病例，所有病例美容效果良好。
采用MSASCI技术进行胸腔镜手术具有良好的美容效果。
