超声刀在剑突肋缘下前纵隔病变微创切除术中的临床应用

Clinical application of harmonic scalpel in subxiphoid and subcostal arch approach for resection of anterior mediastinal lesion

目的评价超声刀在剑突肋缘下前纵隔病变微创切除术中的临床应用价值。方法回顾性分析2015年6月至2017年6月第四军医大学唐都医院胸外科同一诊疗组行前纵隔病变微创切除术217例患者的临床资料。根据手术方式将患者分为两组,超声刀手术组162例,其中男95例、女67例,年龄22~72(46.2±18.7)岁,Ligasure组55例,其中男29例、女26例,年龄31~68(47.7±12.9)岁。统计分析两组患者的手术时间、术中出血量、术中中转率、术后住院时间、患者满意情况、患者疼痛情况及术后并发症等指标。结果所有手术均顺利完成,两组均无死亡、中转开胸病例,两组手术时间[(58.6±34.8)min vs.(72.8±32.6)min,P=0.01]、术中出血量[(36.2±18.7)ml vs.(41.9±12.9)ml,P=0.04]差异具有统计学意义。两组术后住院时间[(4.2±2.6)d vs.(4.5±1.9)d,P=0.36]、患者满意评分(8.6±1.2 vs.8.4±1.7,P=0.34)、术后第1 d疼痛评分(8.3±0.9 vs.8.5±0.6,P=0.13)、第3 d疼痛评分(6.4±1.5 vs.6.9±1.1,P=0.19)、第30 d疼痛评分(1.3±0.7 vs.1.4±0.9,P=0.40)及总体并发症发生率(5.6%vs.9.1%,P=0.35)差异无统计学意义。结论超声刀在剑突肋缘下前纵隔病变微创切除术中具有独特的优势,所有组织的分离、血管的凝断只靠超声刀来完成,在此过程中,掌握超声刀的使用技巧,发挥超声刀的功能非常重要。

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 of46.2±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 Harmonic 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.