[1]俞超詹必成**陈剑李根水周新涛古明博.剑突下胸腔镜全胸腺切除术的近期疗效分析[J].中国微创外科杂志,2026,01(6):329-334.
　Yu Chao,Zhan Bicheng,Chen Jian,et al.Analysis of Shortterm Efficacy of Subxiphoid Thoracoscopic Total Thymectomy[J].Chinese Journal of Minimally Invasive Surgery,2026,01(6):329-334.
点击复制

剑突下胸腔镜全胸腺切除术的近期疗效分析()

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2026年6期
页码:
329-334
栏目:
临床论著
出版日期:
2026-06-22

文章信息/Info

Title:
Analysis of Shortterm Efficacy of Subxiphoid Thoracoscopic Total Thymectomy
作者:
俞超詹必成**陈剑李根水周新涛古明博
(安徽医科大学安庆医学中心心胸外科，安庆246003)
Author(s):
Yu Chao;  Zhan Bicheng;  Chen Jian;  et al.
Department of Cardiothoracic Surgery, Anqing Medical Center, Anhui Medical University, Anqing 246003, China
关键词:
剑突下入路;  胸腔镜; 胸腺切除术
Keywords:
Subxiphoid approach; Thoracoscopy; Thymectomy
文献标志码:
A
摘要:
目的探讨剑突下入路胸腔镜全胸腺切除术的近期疗效。方法回顾性分析2019年4月~2024年12月200例剑突下入路胸腔镜全胸腺切除术的临床资料，其中8例合并重症肌无力。结果195例顺利完成胸腔镜手术(其中20例增加侧胸1.0 cm切口辅助手术)，5例中转开胸。术中并发症9例，其中右心室损伤致心脏压塞1例，左侧无名静脉损伤出血3例，膈神经损伤4例，左侧喉返神经损伤1例。手术时间(124.6±46.7)min，术后胸腔引流管留置时间(1.8±0.5)d。术后切口渗液6例，肺部感染7例，泌尿系统感染6例，胸腔积液2例，无围手术期死亡等并发症。145例获随访，其中1~3个月105例，3~6个月17例，6~12个月6例，1~5年17例。6例胸腺癌中1例复发，8例重症肌无力中1例复发，其余均无复发转移，无死亡。结论剑突下入路胸腔镜全胸腺切除术总体安全可行。
Abstract:
ObjectiveTo investigate the shortterm efficacy of total thymectomy via subxiphoid approach under thoracoscopy.MethodsA retrospective analysis was performed on the clinical data of 200 patients who underwent thoracoscopic total thymectomy via subxiphoid approach from April 2019 to December 2024, among whom 8 cases were complicated with myasthenia gravis.ResultsThoracoscopic surgery was successfully completed in 195 patients (including 20 cases with an additional 1.0 cm lateral thoracic incision for assistance), and conversion to thoracotomy was required in 5 patients. Intraoperative complications occurred in 9 cases, including 1 case of cardiac tamponade caused by right ventricular injury, 3 cases of hemorrhage due to left innominate vein injury, 4 cases of phrenic nerve injury, and 1 case of left recurrent laryngeal nerve injury. The operation time was (124.6±46.7) min, and the indwelling time of thoracic drainage tube was (1.8±0.5) d. Postoperative complications included 6 cases of incision exudation, 7 cases of pulmonary infection, 6 cases of urinary tract infection and 2 cases of pleural effusion, with no perioperative death. A total of 145 patients were followed up, including 105 cases for 1-3 months, 17 cases for 3-6 months, 6 cases for 6-12 months, and 17 cases for 1-5 years. Of the 6 cases of thymic carcinoma, 1 case relapsed; of the 8 cases with myasthenia gravis, 1 case relapsed. No recurrence, metastasis or death occurred in the remaining patients.ConclusionTotal thoracoscopic thymectomy via subxiphoid approach is generally safe and feasible.

参考文献/References:

[1]Zhitao G，Xiuxiu H，Yuan L，et al.Minimally invasive thymectomy could be attempted for locally advanced thymic malignancies:a realworld study with propensityscore matched analysis.J Thorac Oncol,2023,18(5):640-649.
[2]杨健飞,王高祥,陶善明,等.经剑突下与经肋间入路胸腔镜胸腺扩大切除术后急慢性疼痛比较的倾向性评分匹配研究.中国胸心血管外科临床杂志,2023,30(6):842-847.
[3]郑文龙,张淼,武文斌,等.经剑突下与经肋间胸腺扩大切除术治疗重症肌无力的回顾性队列研究.中国胸心血管外科临床杂志,2023,30(6):835-841.
[4]王洪,伍治强.剑突下单孔胸腔镜在前纵隔肿瘤中的应用进展.中国微创外科杂志,2024,24(7):511-514.
[5]卢高俊,王若天,刘宝东,等.剑突下与肋间入路行胸腺扩大切除术治疗重症肌无力的单中心回顾性队列研究.中国胸心血管外科临床杂志,2024,31(8):1119-1126.
[6]陶绍霖,周于钦,康珀铭,等.机器人全孔道前上纵隔巨大肿瘤切除术：肋间与剑突下入路的对比研究.重庆医科大学学报,2026,51(3):314-322.
[7]Kido T,Hazama K,Inoue Y,et al.Resection of anterior mediastinal masses through an infrasternal approach.Ann Thorac Surg,1999,67(1):263-265.
[8]Lau R，Aw K，Abdul AS，et al.Comparing the safety and effectiveness of surgical approaches in thymectomy.Surg Pract,2024,28(3):152-158.
[9]蔡剑桥,施哲,吴亮,等.经剑突下与经肋间单孔胸腔镜胸腺切除术倾向性评分匹配对比研究.中华胸心血管外科杂志,2021,37(11):660-663.
[10]Jia B，Chen C，Gong T，et al.Subxiphoid videoassisted thoracoscopic extend thymectomy with sternal suspension for thymoma.Thorac Cancer,2024,15(30):2185-2192.
[11]Xu H,Zhang L.A novel and simple method for establishing the subxiphoid approach during thoracoscopic thymectomy.Ann Thorac Surg,2019,107(5):e369-e370.
[12]范江,李好,李玉萍,等.双拉钩胸骨悬吊法胸腔镜剑突下全胸腺切除术.中华胸心血管外科杂志,2018,34(4):221-225.
[13]Suda T,Ashikari S,Tochii D,et al.Dualport thymectomy using subxiphoid approach.Gen Thorac Cardiovasc Surg,2014,62(9):570-572.
[14]Yano M,Okuda K,Kawano O,et al.Thoracoscopic thymectomy with tangential partial resection of the innominate vein.Ann Thorac Cardiovasc Surg，2017,23(4):207-210.
[15]赵金兰,陈蔚洋,林琳,等.胸腔镜剑突下单孔双拉钩与经剑突肋缘下三孔胸腺切除术治疗胸腺瘤的回顾性队列研究.中国胸心血管外科临床杂志,2025,32(4):482-487.
[16]Zhang L,Li M,Jiang F,et al.Subxiphoid versus lateral intercostal approaches thoracoscopic thymectomy for nonmyasthenic earlystage thymoma:a propensity scorematched analysis.Int J Surg,2019,67:13-17.
[17]郭清奎,郑敏,徐烨,等.剑突下切口胸腔镜全胸腺切除术治疗胸腺肿瘤9例.中华胸心血管外科杂志,2020,36(3):188-190.
[18]张继朋,周勇安,赵晋波,等.剑突下“三孔式”前纵隔胸腺疾病手术模块化操作及标准流程技术要点:唐都经验.中国胸心血管外科临床杂志,2024,31(12):1735-1742.
[19]徐向南,范江,黄威.剑突下拉钩单孔胸腔镜全胸腺切除术的技术要领:手术流程标准化.中华胸心血管外科杂志,2023,39(5):311-313.
[20]瞿冀琛,黄鑫,赵德平,等.剑突下单孔胸腔镜手术中特殊情况的处理对策.中华胸心血管外科杂志,2019,35(11):659-663.

备注/Memo

备注/Memo:
基金项目：安徽省高校自然科学研究重大项目(2024AH040180)**通讯作者，Email：zbcboy@126.com
更新日期/Last Update: 2026-06-22