Abstract：Objective To investigate the anatomical basis and clinical effect of thoracoscopic thymectomy below the xiphoid. Methods The clinical data of 33 patients [15 males and 18 females, with average age of (53.94±13.37) years] who underwent thoracoscopic thymectomy below the xiphoid from June 2018 to December 2019 at the Department of Thoracic Surgery of the First Affiliated Hospital of Bengbu Medical College were retrospectively analyzed. All patients were diagnosed with thymic tumors before the operation. Postoperative pathological diagnosis included 12 cases of thymoma, 1 case of thymic carcinoma, 3 cases of teratoma, 1 case of thymic hyperplasia, and 16 cases of thymic cyst. The anatomical basis and surgical scope of the procedure were recorded and analyzed. The postoperative drainage volume and drainage time, postoperative hospitalization days, visual analogue scale(VAS) pain score at 24 h after surgery, and postoperative complications were recorded. Results Thymectomy was successfully performed in all patients without conversion to thoracotomy. At the same time, there were two cases of pulmonary wedge resection and two cases of partial pericardiectomy. It is safe to operate through the subxiphoid approach. The visual field was well exposed. The anatomic structure around the thymus is clear, and the adjacent structure of the thymus is completely displayed. The phrenic nerve of the pericardium and superior vena cava, sternum, pericardium and left innominate vein, and the inferior pole of the thyroid are clearly exposed. The postoperative drainage was(429.24±308.34) mL. The postoperative drainage time was (3.61±1.56) days. The postoperative hospital stay was (5.88±3.43) days. The VAS score of pain 24 h after operation was (1.82±0.68) points. No death was recorded during the perioperative period. One patient recovered from myasthenia gravis after mechanical ventilation and medication. One patient had hyponatremia after operation and recovered after sodium supplementation. Conclusions The anatomical approach of thoracoscopic thymectomy below the xiphoid has good surgical safety and clinical effect and is minimally invasive.
张雷, 贡会源, 王彪, 李小军, 唐震, 宋超. 经剑突下入路胸腔镜胸腺切除的解剖基础与临床分析[J]. 中华解剖与临床杂志, 2020, 25(6): 657-661.
Zhang Lei, Gong Huiyuan, Wang Biao, Li Xiaojun, Tang Zhen, Song Chao. Anatomical basis and clinical analysis of thoracoscopic thymectomy below the xiphoid. Chinese Journal of Anatomy and Clinics, 2020, 25(6): 657-661.
徐朋亮, 陈刚, 朱勇俊, 等. 胸腔镜胸腺切除术剑突下入路与侧胸入路的病例对照研究[J]. 中国胸心血管外科临床杂志, 2018, 25(9): 799-803. DOI:10.7507/1007-4848.201710010.Xu PL, Chen G, Zhu YJ, et al.Subxiphoid video-assisted thoracoscopic thymectomy versus traditional video-assisted thoracic surgery thymectomy for myasthenia gravis: a case control study[J]. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(9): 799-803. DOI:10.7507/1007-4848.201710010.
[2]
Zieliński M, Kuzdzał J, Szlubowski A, et al.Transcervicalsu-bxiphoid-videothoracoscopic “maximal” thymectomy—operative technique and early results[J]. Ann Thorac Surg, 2004, 78(2): 404-409. DOI:10.1016/j.athoracsur.2004.02.021.
[3]
朱勇, 施舜缤, 张林, 等. 2种径路胸腔镜全胸腺切除术的对比研究[J]. 中国微创外科杂志, 2019, (19)2: 121-123. DOI:10.3969/j.issn.1009-6604.2019.02.007.Zhu Y, Shi SB, Zhang L, et al. Comparison between right and left thoracic approach video-assisted thoracoscopic extended thymectomy[J]. Chin J Min Inv Surg, 2019, (19)2: 121-123. DOI:10.3969/j.issn.1009-6604.2019.02.007.
[4]
Raza A, Woo E.Video-assisted thoracoscopic surgery versus sternotomy in thymectomy for thymoma and myasthenia gravis[J]. Ann Cardiothorac Surg, 2016, 5(1): 33-37. DOI:10.3978/j.issn.2225-319X.2015.10.01.
[5]
Gu ZT, Mao T, Chen WH, et al.Comparison of video assisted thoracoscopic surgery and median sternotomy approaches for thymic tumor resections at a single institution[J]. Surg Laparosc Endosc Percutan Tech, 2015, 25(1): 47-51. DOI:10.1097/SLE.0000000000000005.
[6]
方文涛, 谷志涛, 陈克能, 等. 胸腺肿瘤微创手术研究进展[J]. 中国肺癌杂志, 2018, 21(4): 269-272. DOI:10.3779/j.issn.1009-3419.2018.04.06.Fang WT, Gu ZT, Chen KN, et al.Minimally invasive surgery in thymic malignances[J]. Chin J Lung Cancer, 2018, 21(4): 269-272. DOI:10.3779/j.issn.1009-3419.2018.04.06.
[7]
谷志涛, 方文涛. 胸腺肿瘤微创切除手术的基本原则与质量控制[J]. 中国胸心血管外科临床杂志, 2019, 26(1): 29-34. DOI:10.7507/1007-4848.201811015.Gu ZT, Fang WT.General principles and quality control of minimally invasive surgery for thymic malignances[J]. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(1): 29-34. DOI:10.7507/1007-4848.201811015.
[8]
Lu Q, Zhao J, Wang J, et al.Subxiphoid and subcostal arch “Three ports” thoracoscopic extended thymectomy for myasthenia gravis[J]. J Thorac Dis, 2018, 10(3): 1711-1720. DOI:10.21037/jtd.2018.02.11.
[9]
谭胜, 张其刚, 刘宏旭, 等. 胸腺形态与胸腺静脉的解剖学特点及其临床意义[J]. 中国临床解剖学杂志, 2006, 24(4): 408-409. DOI:10.13418/j.issn.1001-165x.2006.04.025.Tan S, Zhang QG, Liu HX, et al.The applied anatomy and clinical application of thymus and thymic veins[J]. Chin J Clin Anat, 2006, 24(4): 408-409. DOI:10.13418/j.issn.1001-165x.2006.04.025.
[10]
李飞, 宋媛, 李世勇, 等. 经剑突下胸腺上皮肿瘤胸腔镜手术治疗效果分析[J]. 解放军医药杂志, 2019, 31(8): 17-20. DOI:10.3969/j.issn.2095-140X.2019.08.004.Li F, Song Y, Li SY, et al.Effect of thoracectomy through sub-xiphoid bone in treatment of single central thymic epithelial tumor[J]. Med Pharm J Chin PLA, 2019, 31(8): 17-20. DOI:10.3969/j.issn.2095-140X.2019.08.004.
[11]
Zhao J, Wang J, Zhao Z, et al.Subxiphoid and subcostal arch thoracoscopic extended thymectomy: a safe and feasible minimally invasive procedure for selective stage III thymomas[J]. J Thorac Dis, 2016, 8(Suppl 3): S258-S264. DOI:10.3978/j.issn.2072-1439.2016.02.42.
[12]
Zhang X, Gu Z, Fang W, et al.Minimally invasive surgery in thymic malignances: the new standard of care[J]. J Thorac Dis, 2018, 10(Suppl 14): S1666-S1670. DOI:10.21037/jtd.2018.05.168.
[13]
Agasthian T.Can invasive thymomas be resected by video-assisted thoracoscopic surgery?[J]. Asian Cardiovasc Thorac Ann, 2011, 19(3-4): 225-227. DOI:10.1177/0218492311407977.
[14]
Friedant AJ, Handorf EA, Su S, et al.Minimally invasive versus open thymectomy for thymic malignancies: systematic review and meta-analysis[J]. J Thorac Oncol, 2016, 11(1): 30-38. DOI:10.1016/j.jtho.2015.08.004.
[15]
Agatsuma H, Yoshida K, Yoshino I, et al.Video-assisted thoracic surgery thymectomy versus sternotomy thymectomy in patients with thymoma[J]. Ann Thorac Surg, 2017, 104(3): 1047-1053. DOI:10.1016/j.athoracsur.2017.03.054.
[16]
Fang W, Feng J, Ji C, et al.Minimally invasive thymectomy for locallyadvanced recurrent thymoma[J]. J Vis Surg, 2016, 2: 58. DOI:10.21037/jovs.2016.03.09.
[17]
Yano M, Moriyama S, Haneda H, et al.The subxiphoid approach leads to less invasive thoracoscopic thymectomy than the lateral approach[J]. World J Surg, 2017, 41(3): 763-770. DOI:10.1007/s00268-016-3783-8.
[18]
朱炬, 陈焕文, 刘蔡杨, 等. 经剑突下路径胸腔镜下全胸腺切除术学习曲线分析[J]. 重庆医科大学学报, 2018, 43(9): 1257-1261. DOI:10.13406/j.cnki.cyxb.001798.Ju Z, Chen HW, Liu CY, et al.Analysis on the learning curve of total thymectomy under subxiphoid process thoracoscopy[J]. Journal of Chongqing Medical University, 2018, 43(9): 1257-1261. DOI:10.13406/j.cnki.cyxb.001798.
[19]
黄鑫, 吴亮, 陈健, 等. 剑突下单孔胸腔镜治疗前纵隔肿瘤的回顾性临床研究[J]. 第二军医大学学报, 2019, 40(8): 843-846. DOI:10.16781/j.0258-879x.2019.08.0843.Huang X, Wu L, Chen J, et al.Subxiphoid uniportal video-assisted thoracoscopic surgery for anterior mediastinal tumor: a retrospective clinical study[J]. Acad J Sec Mil Med Univ, 2019, 40(8): 843-846. DOI:10.16781/j.0258-879x.2019.08.0843.
[20]
张淼, 武文斌, 杨敦鹏, 等. 剑突下单孔胸腔镜胸腺扩大切除术的学习曲线分析[J]. 中华胸部外科电子杂志, 2019, 6(3): 146-151. DOI:10.3877/cma.j.issn.2095-8773.2019.03.02.Zhang M, Wu WB, Yang DP, et al.An analysis on learning curve of surxiphoid uniportal video-assisted thoracoscopic extended thymectomy[J]. Chin J Thorac Sur (Electronic Edition), 2019, 6(3): 146-151. DOI:10.3877/cma.j.issn.2095-8733.2019.03.02.
[21]
Yu S, Lin J, Fu X, et al.Risk factors of myasthenic crisis after thymectomy in 178 generalized myasthenia gravis patients in a five-year follow-up study[J]. Int J Neurosci, 2014,124(11): 792-798. DOI:10.3109/00207454.2014.883391.
2020, Vol. 25 
