摘要
目的:探讨广西医科大学第二附属医院对于直径≥5 cm并R0切除的胸腺肿瘤在手术治疗方式上的方案选择，以期为制订大体积胸腺肿瘤的治疗策略提供参考方向。方法:回顾性分析广西医科大学第二附属医院113例直径≥5 cm的胸腺肿瘤并R0切除手术的患者，根据不同手术方式分为胸腔镜胸腺切除术（VATT）组（n＝48）和开放组（n＝65）。比较两组患者的临床基本信息、围手术期资料、病理资料及随访资料等。结果:VATT组患者的术中出血量（P＝0.001）及术后胸管/纵隔管总引流量（P＝0.005）少于开放组，术后肺部感染的概率低于开放组（P＝0.023）。VATT组患者存在肿瘤肺部侵犯（P＝0.006）、心包侵犯（P＝0.002）均少于开放组；VATT组肿瘤直径较开放组小（P<0.001），Masaoka分期Ⅰ~Ⅱ期患者的比例显著高于开放组（P<0.001）。两组的总生存率（P＝0.075）及无病生存率（P＝0.058）差异无统计学意义。二元logistic回归分析结果显示，肿瘤直径≥9 cm（OR＝12.506，95%CI：2.398~65.214，P＝0.003）以及Masaoka Ⅲ期以上（OR＝25.788，95%CI：4.262~156.027，P<0.001）的患者是选择开放术式的独立影响因素。结论:对于≥5 cm经选择的胸腺肿瘤，VATT是一种安全的手术方式，可以达到开放手术相近的疗效，但对于≥9 cm或Masaoka分期Ⅲ期及以上的患者本中心更偏向选择开放术式。
Abstract
Objective:To investigate the appropriate surgical approach for thymic tumors with a diameter ≥5 cm in our center, and to provide the treatment strategies of massive thymoma.Methods:A retrospective analysis was conducted in our hospital, which included 113 patients with thymic tumors ≥5 cm in diameter and underwent surgical R0 resection. The patients were divided into video-assisted thoracoscopic thymectomy (VATT) group (n=48) and conventional thymectomy group (n=65) according to surgical methods. The basic clinical information were compared between the two groups.Results:The intraoperative blood loss (P=0.001) and postoperative chest/mediastinal canal drainage volume (P=0.005) in the VATT group were less than those in the conventional thymectomy group, and the risk of postoperative pulmonary infection was lower than that in the conventional thymectomy group (P=0.023) . Lung invasion (P=0.006) and pericardial invasion (P=0.002) in VATT group were less than those in conventional thymectomy group. In addition, the tumor diameter of VATT group was smaller than that of conventional thymectomy group (P<0.001) , and the proportion of Masaoka stage Ⅰ–Ⅱ patients was higher than that of conventional thymectomy group (P<0.001) . There was no significant difference in overall survival (P=0.075) and disease-free survival (P=0.058) between two groups. Logistic regression analysis suggested that tumor diameter ≥9 cm (OR=12.506, 95%CI: 2.398–65.214, P=0.003) and Masaoka stage ≥ Ⅲ (OR=25.788, 95%CI: 4.262–156.027, P<0.001) were positively associated with conventional thymectomy surgery.Conclusions:VATT is a safe surgical approach for patients with thymic tumors ≥5 cm, which resulted in similar prognosis as conventional thymectomy surgery. However, conventional thymectomy seems more appropriate for patients with thymic tumors diameter ≥9 cm or Masaoka stage Ⅲ or above.
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