胸腔镜后纵隔肿瘤外科治疗效果观察

Postoperative Effect of Thorascopic Surgical Therapy on Posterior Mediastinal Tumors

目的：观察胸腔镜下后纵隔肿瘤的手术治疗效果。方法：回顾性分析37例行后纵隔肿瘤切除手术患者的临床资料,其中采用胸腔镜后纵隔肿瘤切除者26例（胸腔镜组）,同期常规开胸后纵隔肿瘤切除者11例（常规开胸组）,比较两组患者的手术时间、术后疼痛评分（NRS）、术中出血量、术后胸腔闭式引流时间和术后住院时间。结果：胸腔镜组患者的手术时间为45-220（135.6±47.4）min,术中出血量为50-450（221.7±75.3）mL,术后第1天疼痛评分为5-7（6.1±1.1）分,术后第2天疼痛评分为3-5（3.5±1.0）分,术后第3天疼痛评分为1-3（2.5±0.7）分,术后胸腔闭式引流时间为1-4（2.1±1.3）d,术后住院时间为4-7（7.6±1.5）d。常规开胸组手术时间为50-210（129.2±42.3）min,术中出血量为50-500（230.2±80.1）mL,术后第1天疼痛评分为5-8（6.8±1.5）分、术后第2天疼痛评分为4-6（4.7±1.2）分、术后第3天疼痛评分为3-5（3.3±1.0）分,术后胸腔闭式引流时间为2-5（3.5±1.4）d,术后住院时间为6-10（7.6±1.5）d。两组手术时间、术后第1天疼痛评分、术中出血量比较差异无统计学意义（P〉0.05）,两组术后第2天疼痛评分、术后第3天疼痛评分、术后胸腔闭式引流时间、术后住院时间差异有统计学意义（P〈0.05）。结论：胸腔镜下后纵隔肿瘤切除术是一种安全、有效、创伤小的手术方式,对于肿瘤体积较小的患者应该作为首选手术选择。

Objective： To discuss the effect of thoracoscopic surgery for posterior mediastinal tumors. Methods： The clinical data of 37 patients with posterior mediastinal tumor undergone radical resection were retrospectively analyzed. The patient were divided into VATS group（ n = 26） and standard thoracotomy group（ n = 11）. The operation time,postoperative pain score（ numerical rating scale,NRS）,peri-operative bleeding,postoperative chest tube drainage time and hospitalization time were compared between the two groups. Result： VATS was successfully accomplished in all the37 patients. No significant differences were found between the two groups in pain score,the operation time and peri-operative bleeding on first postoperative day（ P〉0. 05）. Significant differences were found between the two groups in pain score,postoperative chest tube drainage time and hospitalization time on the 2nd and 3nd postoperative day（ P〈0. 05）.Conclusion： VATS for Posterior Mediastinal Tumors is a safe,effective procedure and minimally invasive surgical procedure,and should be the first choice for smaller size tumors.