Fujiwara Ayako, Funaki Soichiro, Ose Naoko, Kanou Takashi, Kanzaki Ryu, Minami Masato, Shintani Yasushi
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
J Thorac Dis. 2018 Dec;10(12):6475-6481. doi: 10.21037/jtd.2018.11.73.
The hemi-clamshell (HCS) approach provides a wide anterior view of the mediastinum as well as outstanding exposure of the pulmonary hilum. Here, we evaluated the utility and outcomes of this approach in cases of advanced thymic malignancy with hilar invasion.
We performed a retrospective analysis of 14 patients with thymic epithelial malignancy surgically resected with an HCS approach. All required lung resection because of suspected pulmonary hilar vessel invasion.
Histological findings showed that 8 patients had a thymoma and 6 a thymic carcinoma. Thirteen patients underwent lung resection, a lobectomy or bilobectomy in 8 and wedge resection in 5, while 1 had an exploratory thoracotomy. Seven patients with a thymoma underwent resection of disseminated lesions and 8 of 10 who underwent phrenic nerve resection received diaphragmatic plication through an HCS procedure. There were no postoperative mortalities. Macroscopic complete surgical resection was achieved in 13 cases.
An HCS approach was helpful for lung resection performed for advanced thymic malignancy with hilar invasion by providing multiple access paths to the tumor and hilum, allowing for a sufficient surgical margin. Furthermore, it was useful for resection of disseminated lesions and diaphragmatic plication.
半蛤壳式（HCS）入路可提供纵隔广泛的前视图以及肺门的良好暴露。在此，我们评估了该入路在伴有肺门侵犯的晚期胸腺恶性肿瘤病例中的实用性和疗效。
我们对14例采用HCS入路手术切除的胸腺上皮恶性肿瘤患者进行了回顾性分析。由于怀疑肺门血管受侵，所有患者均需行肺切除。
组织学检查结果显示，8例为胸腺瘤，6例为胸腺癌。13例患者接受了肺切除，其中8例行肺叶切除术或双肺叶切除术，5例行楔形切除术，1例行开胸探查术。7例胸腺瘤患者接受了播散性病变切除术，10例接受膈神经切除术的患者中有8例通过HCS手术进行了膈肌折叠术。无术后死亡病例。13例实现了宏观上的完全手术切除。
HCS入路通过为肿瘤和肺门提供多条进入路径，有助于对伴有肺门侵犯的晚期胸腺恶性肿瘤进行肺切除，从而获得足够的手术切缘。此外，它对播散性病变的切除和膈肌折叠术也很有用。
