探讨胸骨拉钩辅助剑突下单孔胸腔镜在前纵隔肿瘤手术中的可行性和安全性。

2021年1月至2022年6月上海交通大学医学院附属第九人民医院胸外科对前纵隔肿瘤行胸骨拉钩辅助剑突下单孔胸腔镜手术的46例患者。在剑突下作4~5 cm纵行切口，左侧第3肋间应用胸骨拉钩，应用切口保护套单孔胸腔镜手术完整切除前纵隔肿瘤。

46例均接受胸骨拉钩辅助剑突下单孔胸腔镜手术，并顺利完成，2例中转开胸或辅助小切口。手术时间60~90（74.46±7.16） min，出血量50（20~200） mL。胸腔引流管带管时间3~5（3.62±0.58） d，术后住院时间4~10（5.39±1.27）d。术后病理：胸腺瘤A型2例；胸腺瘤AB型4例；胸腺瘤B1型5例；胸腺瘤B2型7例；胸腺鳞状细胞癌3例；胸腺囊肿14例；支气管囊肿4例；畸胎瘤1例；胸腺增生5例；转移性鳞状细胞癌1例。

胸骨拉钩辅助剑突下单孔胸腔镜在前纵隔肿瘤的手术治疗中视野清晰，操作安全，值得临床推广。

To explore the feasibility and safety of sternal traction hook-assisted subxiphoid single-hole thoracoscopy in anterior mediastinal tumor surgery.

From January 2021 to June 2022, 46 cases of anterior mediastinal tumors were treated with single-hole thoracoscopy with a sternal traction hook. A 4–5-cm longitudinal incision was made under the xiphoid process, and the sternal traction hook was inserted under the left third intercostal space/xiphoid process. The anterior mediastinal tumors were completely removed by single-hole thoracoscopy with an incision-protective sleeve.

Subxiphoid single-hole thoracoscopic surgery was successfully completed in 46 cases; however, 2 cases were converted to thoracotomy or additional auxiliary incision. The operation time was 60–90 (74.46±7.16) min, and the median blood loss was 50 (20–200) mL. The duration of thoracic drainage tube placement was 3–5 (3.62±0.58) d, and the postoperative hospital stay was 4–10 (5.39±1.27) d. Postoperative pathology findings were as follows: 2 cases with thymoma type A, 4 with thymoma AB type, 5 with thymoma B1, 7 with thymoma B2, 3 with thymoma squamous cell carcinoma, 14 with thymic cyst, 4 bronchial cyst, 1 teratoma, 5 thymus hyperplasia, and 1 with metastatic squamous cell carcinoma of the thymus.

Single-hole thoracoscopy with the help of a sternal traction retractor is safe and effective in the surgical treatment of anterior mediastinal tumors, and can be considered for widespread clinical use.