RESUMEN
@#Objective To compare the safety and efficacy of the da Vinci robot and thoracoscopic subxiphoid approach for the treatment of anterior mediastinal tumors. Methods The clinical data of patients who underwent anterior mediastinal tumor resection through the subxiphoid approach admitted to the same medical group in the Department of Thoracic Surgery of the First Hospital of Lanzhou University between June 2020 and April 2022 were retrospectively analyzed. According to the surgery approach, the patients were divided into a robot-assisted thoracoscopic surgery (RATS) group and a video-assisted thoracoscopic surgery (VATS) group. The perioperative data and the incidence of postoperative complications were compared between the two groups. Results A total of 79 patients were enrolled. There were 41 patients in the RATS group, including 13 males and 28 females, with an average age of 45.61±14.99 years. There were 38 patients in the VATS group, including 14 males and 24 females, with an average age of 47.84±15.05 years. All patients completed the surgery successfully. Hospitalization cost and operative time were higher or longer in the RATS group than those in the VATS group, and the difference was statistically significant (P<0.05). Intraoperative bleeding, postoperative hospital stay, postoperative water and food intake time, postoperative off-bed activity time, white blood cell count, neutrophil percentage and visual analogue scale (VAS) score on the first postoperative day, white blood cell count and neutrophil percentage on the third postoperative day, duration of analgesic pump use, the number of voluntary compressions of the analgesic pump, and mediastinal drainage volume were all superior to those in the VATS group (P<0.05). The differences in VAS scores on the third postoperative day, duration of drainage tube retention and postoperative complication rates were not statistically different between the two groups (P>0.05). Conclusion RATS subxiphoid anterior mediastinum tumor resection is a safe and feasible surgical method with less injury and higher safety, which is conducive to rapid postoperative recovery and has wide clinical application prospects.
RESUMEN
Objective To compare the perioperative efficacy and safety of da Vinci robot-assisted thoracoscopic surgery (RATS) for treatment of anterior mediastinal tumors through subxiphoid versus lateral thoracic approaches under the laryngeal mask anesthesia. Methods We retrospectively analyzed the clinical data of 102 patients with anterior-mediastinal tumors treated by RATS under laryngeal mask anesthesia completed by the same operator. Forty-five patients underwent the subxiphoid approach (subxiphoid group), and 57 patients were treated with the lateral thoracic approach (lateral thoracic group). The operating time, intraoperative bleeding, and total postoperative drainage volume in the two groups were compared and analyzed. Results All patients successfully completed resection of the anterior mediastinal tumor without the occurrence of perioperative death. In terms of total postoperative drainage volume, postoperative drainage time, postoperative hospital stay, and VAS pain on postoperative days 2 and 3, the subxiphoid group was more advantages (P < 0.05). No statistically significant difference was found between the two groups in terms of operative time, docking time, total operative time, intraoperative bleeding volume, postoperative day 1 VAS pain score, or postoperative complications (P > 0.05). Conclusion The subxiphoid approach of RATS is safe and feasible for resection of anterior mediastinal tumors. Compared with the lateral thoracic approach, the subxiphoid approach has advantages in terms of rapid postoperative recovery and postoperative pain.
RESUMEN
INTRODUCTION@#Children with an anterior mediastinal mass (AMM) need general anaesthesia (GA) or deep sedation for diagnostic procedures more often than adult patients. Anaesthetic management to prevent such complications includes maintenance of spontaneous ventilation (SV) and prebiopsy corticosteroids/radiotherapy.@*METHODS@#We reviewed the medical records of children with AMM who were brought to the operating theatre for diagnostic procedures (prior to chemotherapy) between 2001 and 2013. Our aim was to describe the clinical features, radiological findings and anaesthetic management, as well as determine any association with complications.@*RESULTS@#25 patients (age range 10 months-14 years) were identified during the study period. Corticosteroid therapy was started before the biopsy for one patient. All 25 patients had GA/sedation. A senior paediatric anaesthesiologist was involved in all procedures. Among 13 high-risk patients, SV was maintained in 11 (84.6%) patients, ketamine was used as the main anaesthetic in 8 (61.5%) patients, 6 (46.2%) patients were in a sitting position and no airway adjunct was used for 7 (53.8%) patients. There were 3 (12.0%) minor complications.@*CONCLUSION@#Based on our results, we propose a simplified workflow, wherein airway compression of any degree is considered high risk. For patients with high-risk features, multidisciplinary input should be sought to decide whether the child would be fit for a procedure under GA/sedation or considered unfit for any procedure. Recommendations include the use of less invasive methods, involving experienced anaesthesiologists to plan the anaesthetic technique and maintaining SV.
RESUMEN
To investigate the differences in energy spectrum CT findings between anterior mediastinal lymphoma and thymic carcinoma. Twenty-two cases of anterior mediastinal lymphoma and 28 cases of thymic carcinoma confirmed by biopsy in Tangshan People's Hospital were selected.The CT values and changes of iodine content and water content in lesion sites were measured by energy spectrum analysis software.The differences between anterior mediastinal lymphoma and thymic carcinoma were compared. The single-energy CT value of 40-80 keV in thymus carcinoma was higher than that in anterior mediastinal lymphoma(=0.001,=0.037,=0.042,=0.034,=0.002;=0.016,=0.013,=0.018,=0.024,=0.012).The difference in the single-energy CT value of 90-110 keV between anterior mediastinal lymphoma and thymic carcinoma showed no statistical significance(all >0.05).The concentrations of water in the arterial and venous stages of thymic carcinoma were significantly lower than those in the anterior mediastinal lymphoma(=0.030,=0.037),whereas the iodine concentrations were significantly higher(=0.026,=0.000). Anterior mediastinal lymphoma and thymic carcinoma have remarkably different 40-80 keV single energy CT value and iodine concentration in arterial and venous phases,which may be helpful for the differential diagnosis of these two malignancies.
Asunto(s)
Humanos , Linfoma , Diagnóstico por Imagen , Neoplasias del Mediastino , Diagnóstico por Imagen , Timoma , Diagnóstico por Imagen , Neoplasias del Timo , Diagnóstico por Imagen , Tomografía Computarizada por Rayos XRESUMEN
@#Objective To investigate the safety and feasibility of thoracoscopic surgery of anterior mediastinal tumors via subxiphoid approach under scissors position (SASP) and lateral thoracic approach under lateral position (LALP). Methods Clinical data of 69 patients who received anterior mediastinal tumor excision surgery in our hospital from June 2016 to November 2019 were retrospectively analyzed, including 32 males and 37 females with an average age of 46.38±11.52 years. The clinical effects of the two groups were compared. Results There was no perioperative death or conversion to thoracotomy. There was no statistically significant difference between the two groups in the operative time (123.34±12.64 min vs. 125.05±17.02 min, P=0.642), intraoperative blood loss [50.00 (73.75) mL vs. 50.00 (80.00) mL, P=0.643], tumor diameter (2.75±0.57 cm vs. 2.89±0.45 cm, P=0.787) and total hospital expenses [32.70 (5.30) thousand yuan vs. 32.90 (4.80) thousand yuan, P=0.923]. However, the postoperative catheterization time [2.00 (1.00) d vs. 4.00 (1.50) d, P=0.000], postoperative drainage [260.00 (200.00) mL vs. 400.00 (225.00) mL, P=0.031], postoperative pain index [2.00 (1.00) points vs. 4.00 (2.00) points, P=0.000], postoperative analgesic time [1.50 (1.00) d vs. 3.00 (2.00) d, P=0.000], postoperative fever time [1.50 (1.00) d vs. 2.00 (1.00) d, P=0.000] in the SASP group were better than those in the LALP group. Conclusion Thoracoscopic surgery via SASP is more suitable for the treatment of anterior mediastinal tumor with rapid postoperative recovery and reduced pain, and the postoperative curative effect is definite. However, there is a high requirement for the surgical experience and techniques. It can be promoted in the clinic.
RESUMEN
Acquired thymic cyst are multilocular and they occur de novo or in association with mediastinal neoplasm, systemic autoimmune diseases and trauma. Here, we report a case of acquired multilocular thymic cyst due to non-specific inflammatory etiology in a 42-year old gentleman and our approach to diagnosis and management of anterior mediastinal mass. With no specific clinical symptom, he was diagnosed with anterior mediastinal mass incidentally by imaging studies. Definitive diagnosis of multilocular thymic cyst was obtained by tissue diagnosis of the anterior mediastinal mass resected during the surgery.
RESUMEN
Thymomas are rare tumors in the anterior mediastinum, representing 50% of anterior mediastinal masses and about 20-30% of all mediastinal tumors. They are of unknown etiology; about 50% of patients with thymomas are diagnosed incidentally with chest radiography. Thymoma is classified into different stages, which determine the prognosis and type of management, the standard primary treatment for these tumors is Thymectomy. We present a case of 55-year female presented with shortness of breath, cough with expectoration and fever for past ten days. Chest x-ray revealed mediastinal widening. CECT chest showed a well-circumscribed heterogeneous solid enhancing mass lesion. FNAC was planned that showed features in favour of thymoma. Biopsy was done that confirmed lymphocyte rich type B thymoma.
RESUMEN
Objective • To summarize the anesthetic management of surgical treatment for children with anterior mediastinal tumors. Methods • The anesthetic management data of 55 children with anterior mediastinal tumors were retrospectively analyzed. Children with mediastinal tumors were divided into safe group (n=22), uncertain group (n=19) and unsafe group (n=14) according to the general anesthesia risk classification table, and different anesthesia strategies were given according to different grades. General data, standardized tumor volume (STV), adverse events related to tumors and extubation time were recorded. Results • The general data of safe group, uncertain group and unsafe group had no statistical difference (P>0.05). There were significant differences in STV and extubation time after operation among the three groups (P<0.05). Adverse events related to tumors occurred in the maintenance stage of anesthesia in three groups, and the operation was completed safely after timely treatment. Conclusion • It is conducive to the management of anesthesia combined with the risk classification of general anesthesia in children with mediastinal tumors. The vital signs should be closely monitored during anesthesia, and adverse events should be detected and handled in time to avoid catastrophic events.
RESUMEN
ObjectiveTo explore the feasibility and clinical effect of subxiphoid uniportal video-assisted thoracoscopic surgery in the treatment of the anterior mediastinal tumors. MethodsThe clinical data of 38 patients, who underwent subxiphoid uniportal video-assisted thoracoscopic surgery for anterior mediastinal tumor in Shanghai Pulmonary Hospital of Tongji University from Oct. 2014 to Aug. 2018, were retrospectively analyzed. Among them, 20 were males and 18 were females, the average age was (57.8±14.8) years, and the average diameter of anterior mediastinal tumors was (2.8±1.7) cm. The surgery was performed under video-assisted thoracoscope through an about 4 cm subxiphoid longitudinal incision. ResultsAll the 38 cases of subxiphoid uniportal video-assisted thoracoscopic surgery were performed successfully without conversion to thoracotomy or perioperative death. Except for one patient who received mechanical ventilatory support for 1 week because of worsened myasthenia gravis symptoms, there were no other complications. The operative time, volume of bleeding, volume of drainage on the operation day and hospital stay after surgery were 1-4 (1.9±0.8) h, 10-400 (87.5±68.7) mL, 50-650 (237.4±176.4) mL and 1-19 (4.1±2.9) d, respectively. Postoperative pathology showed 1 case of type A thymoma, 1 case of type B2 thymoma, 1 case of type B3 thymoma, 5 cases of type AB thymoma, 1 case of thymic squamous carcinoma, 6 cases of thymic hyperplasia, 16 cases of thymic cyst, 6 cases of simple thymus and fat and 1 case of bronchial cyst. The visual analogue scale scores on 1, 3 and 6 months after surgery were 3.8±2.2, 1.5±1.4 and 0.8±0.6, respectively. ConclusionSubxiphoid uniportal video-assisted thoracoscopic surgery is a safe, efficient, satisfactory procedure for early stage thymoma, benign anterior mediastinal tumors and some early stage anterior mediastinal malignant tumors, and it can effectively avert the intractable incision pain caused by intercostal nerve injury.
RESUMEN
@#Objective To evaluate the clinical outcomes of harmonic scalpel in subxiphoid and subcostal arch approach for resection of anterior mediastinal lesion. Methods We retrospectively analyzed the clinical data of 217 patients with anterior mediastinal lesion at the Department of Thoracic Surgery of Tangdu Hospital of the Fourth Military Medical University from June 2015 to June 2017, among whom 162 underwent thoracoscopic surgery via subxiphoid and subcostal arch approach with harmonic scalpel (a harmonic scalpel group, 95 males and 67 females at an average age of 46.2±18.7 years ranging from 22 to 72 years) and 55 with Ligasure (a Ligasure group, 29 males and 26 females at an average age of 47.7±12.9 years ranging from 31 to 68 years). Operation time, intraoperative blood loss, intraoperative conversion rate, postoperative hospital stay, patients satisfaction score, patients pain score and postoperative complications were compared between both groups. Results All operations were accomplished successfully, and there was no death or conversion to thoracotomy. There was a statistical difference in operation time (58.6±34.8 min vs. 72.8±32.6 min, P=0.01), and intraoperative blood loss (36.2±18.7 ml vs. 41.9±12.9 ml, P=0.04). There was no statistical difference between the two groups in length of hospital stay (4.2±2.6 d vs. 4.5±1.9 d, P=0.36), pain score at postoperative day 1, 3 and 30 (8.3±0.9 vs. 8.5±0.6, P=0.13; 6.4±1.5 vs. 6.9±1.1, P=0.19; 1.3±0.7 vs. 1.4±0.9, P=0.40), patients’ satisfaction score (8.6±1.2 vs. 8.4±1.7, P=0.34), or incidence of postoperative complications (5.6% vs. 9.1%, P=0.35). Conclusion Har-monic scalpel plays an important role in resection of anterior mediastinal lesion via subxiphoid and subcostal arch approach. All tissues are separated and blood vessels are dissected only by the harmonic scalpel, so it is very important for us to handle the harmonic scalpel skillfully.
RESUMEN
@#Objective To compare the differences in the application of ultrasound scalpel and coagulation hook in thoracoscopic anterior mediastinal tumor surgery and to analyze the respective advantages and indications of the two commonly used energy instruments. Methods The clinical data of 85 patients undergoing thoracoscopic anterior mediastinal tumor surgery in West China Hospital of Sichuan University between June and November in 2017 were prospectively analyzed. There were 45 males and 40 females at age of 50.45 (18–75) years. The patients were divided into three groups including a ultrasound scalpel group (59 patients), a coagulation hook group (17 patients) and a mixed group (9 patients) according to the using time of energy devices. The clinical effect among the three groups were compared. Results No significant difference was found among the three groups in operation time, blood loss, average duration of chest tube drainage or volume of drainage (P>0.05). No significant complications occurred in all groups during operation or after operation. The proportion of subxiphoid approach in the ultrasound scalpel group was higher than that in the other two groups (49/59 vs. 7/17 vs. 5/9, P<0.01). The maximum diameter of the tumor (4.58±2.19 cm vs. 4.05±1.07 cm vs. 3.00±1.45 cm, P<0.05) and the resected tissue weight (103.67±74.78 g vs. 61.17±31.97 g vs. 61.86±34.13 g, P<0.05) were also significantly greater than that in the coagulation hook group or the mixed group. Conclusion Ultrasound scalpel has good safety and reliability in the thoracoscopic anterior mediastinal tumor surgery, and is more suitable for operation in a narrow space.
RESUMEN
Resumen: Las masas mediastinales son poco frecuentes, las mismas están constituidas por un grupo heterogéneo de tumores representan el 3 % de la cirugía torácica en niños (Benignos 75% y malignos 25%), a su vez pueden encontrarse en el mediastino anterior medio o posterior.1 Los síntomas, dependen de su ubicación más que del tamaño o la estirpe tumoral. Los tumores de mediastino anterior, son un desafío para el anestesiólogo por su relación con las estructuras anatómicas con riesgo de colapso del sistema cardiorespiratorio. El objetivo de esta publicación, es presentar un caso clínico de una niña con una masa mediastinal anterior y exponer el manejo anestesiológico del perioperatorio. Se enfatizarán, los conceptos más relevantes en lo referente a: presentación de cuadro clínico, exámenes de diagnósticos e implicancias anestésicas, así como el tratamiento preoperatorio, manejo anestésico del intraoperatorio y sus posibles complicaciones.
Abstract: Mediastinal masses are infrequent; they consist of a heterogeneous group of tumors that represent 3% of all thoracic surgeries performed in children (benign 75%, malignant 25%). They can be found in the mediastinum anterior middle or posterior, and the symptoms seem to depend on their location, rather than the size or tumor strain. Anterior mediastinal tumors are a challenge for anesthesiologists, because of their relationship with anatomical structures and the risk of collapse of the cardiorespiratory system. The objective of this article is to present a clinical case of a girl with an anterior mediastinal mass and to expose the anesthesiological management of the perioperative process. An emphasis is placed on the most relevant concepts regarding: clinical presentation, diagnostic tests, and anesthetic implications, and on preoperative treatment, intraoperative anesthetic management, and possible complications.
Resumo: As massas mediastinais são pouco frequentes, as mesmas consistem em um grupo heterogêneo de tumores que representam 3% da cirurgia torácica em crianças (75% benignos e 25% malignos), podem ser encontrados no mediastino anterior, médio ou posterior. 1 Os sintomas dependem mais da sua localização; que do tamanho ou estirpe tumoral. Os tumores mediastinais anteriores são um desafio para o anestesiologista, devido à sua relação com estruturas anatômicas com risco de colapso do sistema cardiorrespiratório. O objetivo desta publicação é apresentar um caso clínico de uma menina com massa mediastinal anterior e expor a manipulação anestésica do período pré-operatório. Será dada ênfase aos conceitos mais relevantes sobre: a apresentação do quadro clínico, testes diagnósticos e implicações anestésicas, assim como tratamento pré-operatório, manipulação anestésica intra-operatório e suas possíveis complicações.
Asunto(s)
Humanos , Periodo Perioperatorio , Anestesia/métodos , Neoplasias del Mediastino , Neoplasias del Mediastino/cirugía , Neoplasias del Mediastino/diagnósticoRESUMEN
A 21-year-old boy presented with high grade fever, diffuse chest pain and exertional breathlessness of one month duration. Radiologically he had a large lobulated anterior mediastinal mass with necrotic thick enhancing septaes. Histopathology of the mass was suggestive of thymoma and culture from the necrotic aspirate yielded Salmonella typhi. The same pathogen was isolated in subsequent blood and sputum cultures. This current report describes the rare association of salmonella infection with thymoma.
RESUMEN
A seven months old male infant visited Severance Children's Hospital for evaluation of anterior mediastinal mass. With chest computed tomography (CT) image and biopsy, precursor T-cell lymphoblastic lymphoma was suspected but the ultrasonography guided biopsy specimen was insufficient to confirm the disease. Because there was a life-threatening risk to perform open biopsy to the small infant, we started chemotherapy empirically. The mass decreased, however, the lesion increased again and did not respond to the drugs. Finally we decided to resect the anterior mass with sternostomy and the pathology report finally resulted in thymoma.
Asunto(s)
Humanos , Lactante , Masculino , Biopsia , Quimioterapia , Patología , Leucemia-Linfoma Linfoblástico de Células T Precursoras , Tórax , Timoma , UltrasonografíaRESUMEN
A seven months old male infant visited Severance Children's Hospital for evaluation of anterior mediastinal mass. With chest computed tomography (CT) image and biopsy, precursor T-cell lymphoblastic lymphoma was suspected but the ultrasonography guided biopsy specimen was insufficient to confirm the disease. Because there was a life-threatening risk to perform open biopsy to the small infant, we started chemotherapy empirically. The mass decreased, however, the lesion increased again and did not respond to the drugs. Finally we decided to resect the anterior mass with sternostomy and the pathology report finally resulted in thymoma.
Asunto(s)
Humanos , Lactante , Masculino , Biopsia , Quimioterapia , Patología , Leucemia-Linfoma Linfoblástico de Células T Precursoras , Tórax , Timoma , UltrasonografíaRESUMEN
A 37-year-old man who fell from a truck had chest pain and we diagnosed blunt chest trauma. A chest computed-tomography displayed a traumatic cardiac tamponade. The patient was transported to our hospital for emergency surgery. After median sternotomy, there was no injury of heart and great vessels in the pericardial sac but a rupture of the pericardium. Bleeding and hematoma were found in the anterior mediastinal space. The cardiac tamponade was caused by the bleeding from anterior mediastinal space. Usually, blunt cardiac tamponade was caused by the bleeding from cardiovascular organs, however, we encountered a very rare cardiac tamponade due to the bleeding from the anterior mediastinal space.
RESUMEN
We report a case of thymic hyperplasia accompanied by pericardial lipomatosis and right facial hemihypertrophy in an 8-year-old boy. On imaging studies, the hyperplastic thymus had prominent curvilinear and nodular fatty areas simulating a fat-containing anterior mediastinal mass, which is an unusual finding in children. To our knowledge, this is the first report on a child with a combination of thymic hyperplasia, pericardial lipomatosis, and right facial hemihypertrophy. The radiologic findings are presented with a brief discussion.
Asunto(s)
Niño , Humanos , Masculino , Diagnóstico Diferencial , Asimetría Facial/complicaciones , Cardiopatías/complicaciones , Hipertrofia/patología , Lipomatosis/complicaciones , Imagen por Resonancia Magnética , Pericardio/patología , Hiperplasia del Timo/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
Primary anterior mediastinal neoplasms account for 50% of all mediastinal masses with thymomas being the most common. These tumors demonstrate T1-20 1, Tc-99m sestamibi, and Tcc99m tetrofosmin uptake during SPECT myocardial scintigraphy A 60-year-old Filipino with hypertension, dyslipidemia and prior history of ischemic stroke underwent Tc-99m sestamibi SPECT dipyridamole stress. Inhomogeneous tracer uptake of the left ventricle in the inferior and inferolateral region was noted which was attributed to diaphragmatic attenuation. Gated SPECT showed normal myocardial thickening and wall motion. Extracardiac mediastinal activity was visualized on both the resting and stress images. Computed tomography scan demonstrated two (2) well-defined homogeneously enhancing lesions in the left anterior mediastinum most likely a thymoma. Specialists who interpret myocardial scintigrams should be aware of the causes of non-cardiac uptake so that unanticipated focal extracardiac accumulation during myocardial scintigraphy will lead to further investigation to establish the diagnosis of mediastinal tumors.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Dipiridamol , Dislipidemias , Ventrículos Cardíacos , Hipertensión , Neoplasias del Mediastino , Mediastino , Imagen de Perfusión Miocárdica , Miocardio , Especialización , Accidente Cerebrovascular , Tecnecio Tc 99m Sestamibi , Timoma , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos XRESUMEN
Mediastinal masses may cause compression of vital structures such as major airways, the superior vena cava and, rarely, the pulmonary artery. The latter could cause cardiorespiratory compromise during or after induction of general anesthesia. We observed a case of a 45-year-old woman with an anterior mediastinal mass that caused severe hypoxemia and hypotension during sternotomy for mass resection, probably by pulmonary artery compression. Immediately upon opening the chest to relieve pulmonary artery compression, oxygen saturation and blood pressure returned to normal. Therefore, we suggest that unexpected hypoxemia and hypotension in a patient with a mediastinal mass can be due to pulmonary artery compression.
Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Anestesia General , Hipoxia , Presión Sanguínea , Hipotensión , Oxígeno , Arteria Pulmonar , Esternotomía , Tórax , Vena Cava SuperiorRESUMEN
Se presenta el caso de un hombre joven con tumor sólido del mediastino anterior y superior, con elevación de algunos marcadores tumorales. El diagnóstico anatomopatológico fue seguido de quimioterapia.
A young man presented with a solid mass in the anterosuperior mediastinum and superior vena cava syndrome. Some tumor markers were elevated. Diagnosis was followed by chemotherapy.