纵隔囊肿和肿块切除术的传统方法是通过正中胸骨切开术或开胸手术开放。随着微创技术的出现,已有通过电视辅助胸腔镜(VATS)和机器人辅助胸腔镜手术(RATS)完成的成功病例.虽然纵隔囊肿并不常见,它们是胸外科实践中的重要且相关的话题。因此,本临床实践综述旨在总结和强调一些关键病例系列和回顾性研究,以便对每种方法提供见解。此外,对其他方法进行了简要回顾,如剑突下,以及支气管内超声在纵隔囊肿治疗中的应用。在这次审查中,已确定的VATS和RATS的益处主要在于患者体验的质量改善-减少住院时间(LOS)和疼痛-不影响患者结局.然而,开放的方法仍然是一个可行的选择,特别是对于大型囊肿的管理或作为纾困方案。当外科医生用VATS或RATS接近并遇到出血或困难的解剖平面时,文献中一致认为转换为开胸手术是安全的下一步.我们的临床实践是在可能的情况下尝试VATS或RATS方法治疗纵隔囊肿。本次审查使用的数据在很大程度上依赖于病例报告和病例系列,因此是本次临床实践综述的主要局限性。
The traditional approach to mediastinal cyst and mass resection has been open via median sternotomy or thoracotomy. With the advent of minimally invasive techniques, there have been successful cases completed via video-assisted thoracoscopic (VATS) and robot-assisted thoracoscopic surgery (RATS). Although mediastinal cysts are uncommon, they are a significant and relevant topic in the practice of thoracic surgery. Thus, this clinical practice
review aims to summarize and highlight some of the key case series and retrospective studies in order to provide insight on each of the approaches. In addition, there is a brief
review of other approaches, such as subxiphoid, and the utility of endobronchial ultrasound in the management of mediastinal cysts. In this
review, the identified benefits of VATS and RATS lie largely in quality improvement of the patient experience-decreased length of stay (LOS) and pain-without compromising patient outcomes. However, the open approach remains a viable option, particularly for the management of large cysts or as a bail-out option. When surgeons approach with VATS or RATS and encounter bleeding or difficult dissection planes, it is consistent in the literature that conversion to thoracotomy is the safe next step. Our clinical practice is to attempt VATS or RATS approach for mediastinal cysts when possible. The data used for this
review relies heavily on case reports and case series, and thus is the main limitation of this clinical practice
review.