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目的探讨单操作孔全胸腔镜手术治疗小儿后纵隔肿瘤的疗效。方法 2011年1月~2014年12月对36例患儿行单操作孔全胸腔镜下后纵隔肿瘤切除术,患侧卧位,腋中线第7~8肋间做腔镜孔,腋前线第3~5肋间做2~3 cm操作孔,选择电钩或超声刀沿肿瘤边缘分离组织,避开周围重要血管、神经、乳糜管等结构,完整切除肿瘤。结果所有患儿均在单操作孔下完成手术,无中转开胸。手术时间56~133 min,平均82 min;术中出血量10~50 ml,平均25 ml;术后住院时间3~10 d,平均6.2 d。住院期间无死亡,2例术后出现霍纳综合征,其余患儿恢复顺利。术后病理:单纯囊肿3例,畸胎瘤1例,神经纤维瘤2例,节细胞神经瘤22例,节细胞神经母细胞瘤6例,神经母细胞瘤2例。所有患儿随访1~43个月,平均19个月,无肿瘤复发,1例霍纳综合征患儿半年后恢复正常,1例无明显好转。结论单操作孔全胸腔镜下治疗小儿后纵隔肿瘤疗效满意。
Objective To investigate the effect of single operation hole thoracoscopic surgery on mediastinal tumors in children. Methods From January 2011 to December 2014, 36 children underwent single-port thoracoscopic resection of mediastinum tumor. The lateral and medial axillary mid-7th to 8th intercostal space were excised. The anterior axillary line 3 ~ 5 intercostal do 2 ~ 3 cm operation hole, choose electric hook or ultrasonic knife along the edge of the tumor tissue separation, to avoid the surrounding important blood vessels, nerves, chylothorax and other structures, the complete removal of the tumor. Results All children underwent surgery under a single operation hole without thoracotomy. The operation time ranged from 56 to 133 minutes (average 82 minutes). The intraoperative blood loss was 10 to 50 ml (average 25 ml). The postoperative hospital stay was 3 to 10 days (mean, 6.2 days). There were no deaths during the hospitalization, and 2 had Horner’s syndrome after surgery, and the rest of the children recovered well. Postoperative pathology: simple cyst in 3 cases, teratoma in 1 case, neurofibroma in 2 cases, 22 cases of ganglioneuroma, ganglioneuroblastoma in 6 cases, neuroblastoma in 2 cases. All patients were followed up for 1 ~ 43 months, an average of 19 months, no tumor recurrence, 1 case of Horner’s syndrome returned to normal after six months, 1 case no significant improvement. Conclusion The single operation hole thoracoscopic treatment of mediastinal tumors in children with satisfactory results.