摘要
目的:对于早期的胸腺肿瘤，倡导部分胸腺切除或者肿瘤切除的声音一直存在。半胸腺切除的概念基于胸腺的解剖基础，此切除范围位于一侧胸腺的早期胸腺瘤或良性胸腺病灶中。现描述该手术方案的早期术后结果和短期随访结果。方法:在12个月的时间内，共31名患者接受微创半胸腺切除术，汇总并简述所有患者的临床特征、合并症、术后结果、病理结果以及短期随访结果。结果:所有患者接受了微创下的半胸腺切除术。其中男11例，女20例；年龄平均52.7（35~77）岁。26例患者有不同程度的合并症，其中12例伴超重，9例伴高血压，3例伴糖尿病，1例伴白细胞减少，1例伴子宫内膜间质肉瘤。31台前外侧入路半胸腺切除术均进展顺利，手术时间平均为60.83（31~91）min，术中失血量平均为49.5（20~200）mL，无术中不良事件和术后短期并发症，围手术期的死亡为0。术后平均住院时间为1.3（1~2） d，术后第1天平均引流量为77.8（0~350） mL，术后胸腔引流管平均留置时间为0.7（0~2） d，10例患者在手术当天拔除胸腔引流管。根据国际抗癌联盟（UICC）的TNM病理分期，术后病理结果显示21例为胸腺瘤（均为T1aN0M0），7例为畸胎瘤，3例为血管瘤，随访6~12个月并没有复发的病例。结论:基于胸腺解剖的新的胸腺切除范围——半胸腺切除术用于治疗位于一侧胸腺的早期、不伴有重症肌无力且胸腺上皮来源的肿瘤以及良性病变，是一种安全有效的切除方式，有较好的围手术期结果和短期肿瘤学结果。与传统的全胸腺切除相比，理论上半胸腺切除可为部分患者提供更快、更安全的手术体验。
Abstract
Objective:For early-stage thymic epithelial tumors (TETs) , advocation for partial thymectomy or even thymomectomy has always existed. The concept of hemi-thymectomy is based on the anatomical structure of the thymus; and it is devised to be applied to early-stage TETs and benign thymic lesions located entirely on one lobe of the thymus. This article summarized our preliminary experience with this novel surgical extent including both peri-operative outcomes and short-term prognosis.Methods:Over a 12-month period, a total of 31 patients underwent minimally invasive hemi-thymectomy. The clinical characteristics, co-morbidities, peri-operative results, final pathology and short-term prognosis of these patients were summarized.Results:A total of 11 males and 20 females with a mean age of 52.7 (35–77) years underwent minimally invasive hemi-thymectomy for their anterior mediastinal lesions. Twenty-six of them had various degrees of co-morbidities: 12 with overweight, 9 with hypertension, 3 with diabetes mellitus, 1 with leukopenia and 1 with endometrial stromal sarcoma. All 31 hemi-thymectomies via the anterolateral minimally invasive approach were successful without intra-operative adverse events. The mean operation time was 60.83 (31–91) min. The mean intra-operative blood loss was 49.5 (20–200) mL. There were no deaths in peri-operative period. The mean post-operative hospital stay was 1.3 (1–2) days; the mean drainage volume on the first post-operative day was 77.8 (0–350) mL. The mean chest drainage tube indwelling time was 0.7 (0–2) days. Drainage tubes of 10 patients were removed within 24 hours after the surgery. The pathology results showed 21 thymomas, 7 teratomas and 3 hemangiomas. All 21 thymomas were UICC pT1aN0M0. No recurrence was observed during the follow-up (6–12 months) .Conclusions:Hemithymectomy, a new range of thymectomy based on thymic anatomy, is used to treat early-stage, non-myasthenia gravis-derived tumors of thymic epithelial origin and benign lesions located in one thymus. Preliminary exploration suggests that this is a safe and effective resection method with good perioperative and short-term oncological outcomes. In theory, hemithymectomy has inherent advantages over traditional total thymectomy, and can provide a faster and safer surgical experience for a selected group of patients.
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