改良经剑突下及肋弓下切口术式与传统经胸壁切口术式切除胸腺肿瘤的临床疗效对比研究

Clinical Comparative Study of Modified Subxiphoid-subcostal Approach and Traditional Transthoracic Approach for the Resection of Thymic Tumors

目的比较改良经剑突下及肋弓下切口术式与传统经胸壁切口术式切除胸腺肿瘤的临床疗效。方法选取2013年1月—2017年12月于沧州市中心医院胸外科行胸腺肿瘤切除术的患者175例,根据切口入路不同分为剑突下切口组(95例)与胸壁切口组(80例)。剑突下切口组应用改良经剑突下及肋弓下切口术式,胸壁切口组应用传统经胸壁切口术式。比较两组患者手术时间、术中出血量、术后带管时间、住院时间及术后第1、3天视觉模拟评分法(VAS)评分、术后并发症情况。结果剑突下切口组手术时间、术后带管时间、住院时间短于胸壁切口组,术中出血量少于胸壁切口组,术后第1、3天VAS评分及并发症发生率低于胸壁切口组(P<0.05)。结论改良经剑突下及肋弓下切口术式切较传统经胸壁切口术式切除胸腺肿瘤的手术时间短,操作更简单,患者创伤更小,术后疼痛更轻,恢复快,住院时间短,且并发症少。

Objective To compare the clinical efficacy of modified subxiphoid-subcostal approach with that of traditional transthoracic approach for the resection of thymic tumors（RTT）.Methods The subjects enrolled in this study were 175 patients undergoing RTT in Department of Thoracic Surgery,Cangzhou Central Hospital from January 2013 to December 2017.95 of them receiving RTT via modified subxiphoid-subcostal approach and 80 via the traditional transthoracic approach were assigned to subxiphoid incision group and chest wall incision group,respectively.The clinical efficacy of these two approaches was compared from the duration of RTT,intraoperative blood loss,duration of postoperative chest tube drainage,length of stay,VAS score assessed on the 1 st,3 rd days after surgery,and incidence of postoperative complications.Results Compared with the chest wall incision group,subxiphoid incision group demonstrated much shorter duration of RTT,duration of postoperative chest tube drainage and length of stay,significantly less intraoperative blood loss,obviously lower VAS score on the 1 st,3 rd days after surgery as well as notable lower incidence of postoperative complications（P〈0.05）.Conclusion RTT via the modified subxiphoid-subcostal approach is more simple to operate,requiring shorter duration.Moreover,it is contributive to smaller incision,lighter degree of postoperative pain,quicker recovery,shorter length of stay as well as lower incidence of postoperative complications among the patients.