Thymoma surgery

Incision selection: Thymoma protruding to one side mostly adopts incision in anterolateral intercostal region, and incision in the middle of anterior chest can be used for those protruding to both sides. In recent years, the application of median thoracotomy has increased, and the contralateral thymus is removed except thymoma to prevent the possibility of myasthenia gravis in the future. This spring, the tumor was removed through a bilateral transverse chest incision through the sternum. The median incision of the anterior chest does not enter the chest cavity, which reduces the interference to the patient's respiratory function after operation and avoids postoperative respiratory complications. Someone resected thymoma through a neck incision. The indications are elderly patients with contraindications for thoracotomy. The tumor is small and close to the neck.

Problems that should be paid attention to during operation: there is no difficulty in completely removing solitary benign thymoma without adhesion, and the operation can be successfully completed, but the difficulty should be fully estimated for some complicated cases. Malignant thymoma should be explored first, and the relationship between tumor and surrounding organs should be made clear before dissection. Thymoma is located at the bottom of the upper mediastinum, at the junction of the heart and great vessels. Malignant thymoma can adhere and infiltrate around; When the tumor grows, the adjacent tissues and organs are pushed and the normal anatomical relationship changes; Adhesion and thickening of fibrous connective tissue make it difficult to distinguish it from blood vessels. All these may cause accidental damage to blood vessels during surgery, resulting in massive bleeding. The surgeon's judgment on the resectability of the resulting tumor should be considered during the operation. When the tumor has invaded the innominate vein or superior vena cava, or the blood vessels in the tumor are wrapped, or the tumor and surrounding tissues are frozen, we should be cautious at this time, stop the operation, only take pathological biopsy and give radiotherapy after operation. If the tumor has adhesion and infiltration with the great vessels, but it can still be separated, it can be dissected step by step, from shallow to deep, from easy to difficult, first make it loose, then free the tumor, and finally remove it after its pedicle clip.

During dissection, each fibrous tissue or cord should be clamped and cut off to avoid damaging blood vessels and increasing the difficulty of operation. If you accidentally hurt a blood vessel, don't panic and blindly clamp it to stop bleeding. First, use gauze pad to press out the breach of the enemy country, prepare the aspirator, and at the same time speed up the blood transfusion. After the blood is sucked in the operating field, determine the location and scope of the injury, and then decide whether to suture or repair it directly.