知识与财富的链接
目的探讨经颈部切口的全胸腺切除术治疗前纵隔胸腺内小病灶的临床应用价值。方法2007年3月～2011年12月行经颈部切口全胸腺切除术13例，使用常规手术器械及头灯照明，经颈横切口从胸骨后间隙完整游离肿瘤及全胸腺并切除。结果1例因游离中发现侵犯左无名静脉中转胸骨正中切口切除肿瘤。12例经颈部切口全胸腺切除术平均手术时间48．1min（38—60min），平均术中出血量45ml（30～50m1），平均术后住院3．7d（2～7d）。1例术后第2天出现房颤，药物治疗后转窦性心率。13例均无手术相关性死亡。术后病理：MasaokaI期胸腺瘤2例，Ⅱ期胸腺瘤3例，Ⅲ期胸腺瘤1例，胸腺增生3例，胸腺脂肪瘤、胸腺囊肿、异位甲状旁腺囊肿、巨大淋巴结增生各1例。5例MasaokaI／Ⅱ期胸腺瘤术后均未行放化疗，随访3～57个月均存活，未见肿瘤复发；1例MasaokaⅢ期胸腺瘤术后放疗50Gy，随访14个月，无复发；胸腺增生3例术后症状均明显改善，随访14～28个月均完全缓解；其余4例良性胸腺肿瘤随访31—59个月，均存活，未见肿瘤复发。结论经颈部切口的全胸腺切除术治疗前纵隔胸腺内早期小病灶是安全可行的。对于合并胸腺内病变的早期重症肌无力患者及≤5cm的MasaokaI／Ⅱ期胸腺瘤患者的手术确切疗效有待于进一步病例数的积累。
Objective To investigate the clinical value of transcervical thymectomy for the treatment of small thymic lesions. Methods From March 2007 to December 2011, 13 patients underwent transcervical thymectomy. Through a lower transcervical incision enblock thymectomy by blunt mobilization in the retrosternal space was successfully completed in 12 patients. Another one patient was converted to total sternotomy during the operation because of tumor invasion into the left innominate vein. Results The mean operation time of the 12 transcervical patients was 48.1 min （38 -60 min）. The mean blood loss during the operation was 45 ml （30-50 ml）. The mean postoperative hospital stay was 3.7 days （2 -7 d）. And the postoperative complication rate was 8% （1 patient with atrial fibrillation）. There was no operative mortality in the 13 patients. Postoperative pathological examination confirmed that there were 2 cases of Masaoka stage I thymoma, 3 cases of Masaoka stage II thymoma, 1 case of Masaoka stage III thymoma and 3 cases of thymic hyperplasia. The remaining 4 patients were validated as thymic lipoma, thymic cyst, intrathymic parathyroid cyst, and giant lymph node hyperplasia respectively. All the patients with Masaoka stage I / II thymoma received no adjuvant therapy postoperatively. During a 3- to 57-month follow-up, no metastasis or relapse was found. As for the 3 myasthenia gravis patients with thymic hyperplasia, the symptoms were improved significantly after the operation. They all reached complete stable response during a 14- to 28-month follow-up. In the 4 patients with benign tumors, no relapse was found during a 31- to 59-month follow-up. For the patient with Masaoka stage Ⅲ thymoma, 50 Gy radiotherapy was applied postoperatively,and no metastasis or relapse was found during a 14-month follow-up. Conclusions Transcervical thymectomy for small thymic lesions and mild myasthenia gravis complicated with thymic hyperplasia is technically feasible. As for Masaoka stage I or II small thymoma （less than or equal to 5 cm） and early myasthenia gravis complicated with thymic hyperplasia, additional clinical observations are required.
