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中华胸部外科电子杂志 ›› 2023, Vol. 10 ›› Issue (01) : 34 -41. doi: 10.3877/cma.j.issn.2095-8773.2023.01.06

纵隔专题

局部晚期胸腺肿瘤全胸腔镜治疗的实践与争议
陈立如1, 习锦峰1, 柳阳春1, 徐全1,()   
  1. 1. 330006 南昌,江西省人民医院(南昌医学院第一附属医院)胸外科
  • 收稿日期:2022-07-12 修回日期:2022-08-02 接受日期:2022-08-09 出版日期:2023-02-28
  • 通信作者: 徐全

Practices and controversies of thoracoscopic surgery for locally advanced thymic malignancies

Liru Chen1, Jinfeng Xi1, Yangchun Liu1, Quan Xu1,()   

  1. 1. Department of Thoracic Surgery, Jiangxi Provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang 330006, China
  • Received:2022-07-12 Revised:2022-08-02 Accepted:2022-08-09 Published:2023-02-28
  • Corresponding author: Quan Xu
引用本文:

陈立如, 习锦峰, 柳阳春, 徐全. 局部晚期胸腺肿瘤全胸腔镜治疗的实践与争议[J]. 中华胸部外科电子杂志, 2023, 10(01): 34-41.

Liru Chen, Jinfeng Xi, Yangchun Liu, Quan Xu. Practices and controversies of thoracoscopic surgery for locally advanced thymic malignancies[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2023, 10(01): 34-41.

局部晚期胸腺肿瘤的治疗一直以来都是临床关注的焦点,外科治疗是可切除局部晚期胸腺肿瘤最主要的治疗方式。近二十余年来,电视胸腔镜外科手术(VATS)快速发展,其在局部晚期胸腺肿瘤治疗中的探索未曾中止。早期阶段,VATS下切除局部晚期胸腺肿瘤的安全性和肿瘤学效果饱受质疑。近年来,随着机器人辅助胸腔镜手术(RATS)和剑突下入路胸腔镜(SX-VATS)的应用,以及胸骨拉钩等辅助器械的使用,局部晚期胸腺肿瘤的微创治疗取得了一定的突破,但因为考虑安全性和肿瘤学效果问题,其全胸腔镜治疗仍然受到很大限制。细致全面的术前评估是局部晚期胸腺肿瘤采用全腔镜治疗的前提。

The treatment of locally advanced thymic malignancies has always been the focus of clinical attention, and surgery plays a predominant role in treating resectable locally advanced thymic malignancies. In the past two decades, video-assisted thoracoscopic surgery (VATS) has developed rapidly, and its exploration in the treatment of locally advanced thymic malignancies has never stopped. In the early years, the safety and oncological effects of VATS for locally advanced thymic malignancies were questioned. In recent years, with the application of robotic-assisted thoracoscopic surgery (RATS) and subxiphoid VATS (SX-VATS) , and the use of auxiliary devices such as sternal retractors, some breakthroughs have been made in minimally invasive treatment of locally advanced thymic malignancies, but the thoracoscopic treatment is still very limited due to controversy in safety and oncological effects. Cautious and comprehensive preoperative evaluation is the prerequisite for the thoracoscopic surgery of locally advanced thymic malignancies.

表1 VATS切除局部晚期胸腺肿瘤的早期报道
表2 RATS在局部晚期胸腺肿瘤的应用
表3 剑突下入路胸腔镜在局部晚期胸腺肿瘤的应用
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