胸腔镜经剑突下与经侧胸肋间入路纵隔肿物切除术临床疗效的比较

Comparison of Clinical Effects of Mediastinal Tumor Resection by Subxiphoid Approach and Lateral Intercostal Approach

目的:探讨经剑突下入路电视辅助胸腔镜手术(S-VATS)与经侧胸肋间入路电视辅助胸腔镜手术(I-VATS)切除纵隔肿物的安全性和临床疗效。方法:回顾性分析深圳大学第一附属医院胸外科自2017年1月至2021年11月收治的143例患有纵隔肿物的患者,其中符合本研究纳入和排除标准的研究对象有128例,按照观察性研究方法将其分为观察组和对照组,观察组53例采用S-VATS切除纵隔肿物,对照组75例采用I-VATS切除纵隔肿物。比较两组患者的临床特征、手术指标(手术时间和手术中出血量)及手术后临床观察指标[手术后引流管的留置时间、胸腔的引流量、术后住院时间、24 h疼痛评分、是否转入重症监护病房(ICU)、并发症及住院费用]的差异。结果:两组患者的年龄、病理类型比较,差异具有统计学意义(P<0.05);两组患者身高、体质量、体质量指数(BMI)、性别、吸烟史、糖尿病史、重症肌无力史和高血压史比较,差异均无统计学意义(P>0.05);两组患者在手术时间、手术中出血量、手术后引流管留置时间、手术后胸腔的引流量、手术后住院时间及手术后并发症方面比较,差异均无统计学意义(P>0.05);观察组患者的术后24 h疼痛评分、住院费用均低于对照组,差异均具有统计学意义(P<0.05)。结论:S-VATS切除纵隔肿物有更良好的手术视野和手术安全性,与I-VATS相比,在手术切口疼痛和住院费用方面占有优势,更有助于促进患者手术后的快速康复、提高患者近期生活质量。

Objective To investigate the safety and clinical efficacy of video-assisted thoracic surgery via subxiphoid approach(S-VATS)and video-assisted thoracic surgery via lateral intercostal approach(I-VATS)for mediastinal mass resection.Methods A total of 143 patients with mediastinal mass resection admitted to thoracic surgery department of the First Affiliated Hospital of Shenzhen University from January 2017 to November 2021 were retrospectively analyzed.Among them,128 subjects who met the inclusion and exclusion criteria of this study were divided into an observation group and a control group according to the observational research method.53 cases in the observation group were treated with S-VATS to remove mediastinal masses,while 75 cases in the control group were treated with I-VATS to remove mediastinal masses.Comparison the differences of the two groups of patients with clinical characteristics,surgical index(operative time and intraoperative blood loss),and clinical observation index after surgery[drainage tube indwelling time after surgery,the chest of flow rate,length of hospital stay,postoperative 24 h pain score,whether into the intensive care unit(ICU),the differences between the complications and hospitalization expenses].Results There were statistically significant differences in age and pathological types between the two groups(P<0.05).There was no significant difference in height,body weight,body mass index(BMI),gender,smoking history,diabetes history,myasthenia gravis history and hypertension history between the two groups(P>0.05).There was no significant difference in operation time,intraoperative blood loss,postoperative drainage tube indwelling time,postoperative thoracic drainage volume,postoperative hospital stay and postoperative complications between the two groups(P>0.05).The 24 h postoperative pain score and hospitalization cost of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).Conclusion Compared with I-VATS,S-VATS has better surgical field and safety in the resection of mediastinal masses.S-VATS has advantages in surgical incision pain and hospitalization cost,which is more conducive to promote the rapid recovery of patients after surgery and improve the short-term quality of life of patients.