Roviaro G, Rebuffat C, Varoli F, Vergani C, Maciocco M, Scalambra S M
Department of Surgery, S. Giuseppe Hospital, University of Milan, Italy.
Ann Thorac Surg. 1994 Dec;58(6):1679-83; discussion 1683-4. doi: 10.1016/0003-4975(94)91658-6.
Mediastinal masses are generally excised through wide thoracotomies or median sternotomies. These lesions are often benign, usually asymptomatic, discovered incidentally, and relatively easy to resect. For these reasons, a minimally invasive approach is appropriate. Videothoracoscopy allows an optimal exploration of the pleural cavity and a panoramic view of the mass. Dissection is usually easy to perform, and the mass can be extracted from the thorax through a trocar incision or through a limited "utility thoracotomy." To avoid possible tumor seeding, the mass is inserted in a plastic bag before extraction. From September 1991 to January 30, 1994, 20 mediastinal masses (6 thymomas, 2 thymic cysts, 1 hyperplastic thymus, 1 fibrous tumor of the mediastinum, 2 pleuropericardial cysts, 2 thoracic teratomas, 2 large thoracic lipomas, 3 neurogenic tumors, and 1 bronchogenic cyst) were removed through such a minimally invasive approach. Eighteen patients had an uneventful postoperative course. Two patients hemorrhaged in the immediate postoperative period, and repeat thoracoscopy was done. In 1 patient, electrocoagulation of a bleeding intercostal artery controlled the hemorrhage. In the other, the source of bleeding could not be found, and removal of the clots and irrigation of the cavity stopped the hemorrhage. Further data and long-term follow-up are necessary, but videothoracoscopy offers a new, less invasive approach for the management of noninvasive mediastinal masses.
纵隔肿块通常通过广泛的开胸手术或正中胸骨切开术切除。这些病变往往是良性的，通常无症状，多为偶然发现，且相对容易切除。基于这些原因，采用微创方法是合适的。电视胸腔镜检查能够对胸腔进行最佳探查，并提供肿块的全景视野。解剖操作通常易于进行，肿块可通过套管切口或有限的“实用开胸术”从胸腔取出。为避免可能的肿瘤种植，在取出肿块前将其装入塑料袋中。从1991年9月至1994年1月30日，通过这种微创方法切除了20个纵隔肿块（6例胸腺瘤、2例胸腺囊肿、1例增生性胸腺、1例纵隔纤维瘤、2例胸膜心包囊肿、2例胸段畸胎瘤、2例巨大胸段脂肪瘤、3例神经源性肿瘤和1例支气管囊肿）。18例患者术后过程顺利。2例患者在术后即刻出血，遂进行了再次胸腔镜检查。其中1例患者通过电凝出血的肋间动脉控制了出血。另一例患者未能找到出血源，通过清除血块和冲洗胸腔止住了出血。虽然还需要更多数据和长期随访，但电视胸腔镜检查为无创性纵隔肿块的治疗提供了一种新的、侵入性较小的方法。
