胸腔镜下两种不同手术入路治疗胸腺瘤的疗效比较

Comparison of the effect of two different surgical approaches for thymoma under thoracoscopy

目的比较胸腔镜（VATS）经肋间手术与经剑突下手术治疗早期胸腺瘤的临床效果，探讨VATS经剑突下手术治疗胸腺瘤的可行性及临床应用价值。方法选取京山县人民医院和华中科技大学同济医学院附属同济医院2014年1月至2017年1月收治符合Masaoka分期法Ⅰ-Ⅱ期诊断标准的胸腺瘤患者30例为研究对象，根据手术方式不同分为两组。观察组12例采用VATS经剑突下手术，对照组18例采用VATS经肋间手术。比较两组手术时间、术中出血量、引流时间、住院天数、疼痛程度、抗菌时间、并发症发生率、患者满意度等。结果两组术前一般资料差异均无统计学意义。观察组手术时间、术中出血量、术后引流时间、抗菌时间、术后住院天数分别为（102．2±26．6）min、（105．9±29．4）mL、（3．8±1．4）d、（6．8±0．3）d、（8．5±1．6）d，对照组分别为（124．6±35．1）min、（255．6±82．8）mL、（5．2±1．2）d、（9．3±0．8）d、（14．4±1．8）d，两组差异均有统计学意义（t=1．516、2．517、2．857、4．462、3．327，均P〈0．05）；两组并发症发生率（8．33％比16．67％）、满意度（82％比59％）差异均有统计学意义（x2=4．013、4．427，均P〈0．05）。随访期间，两组患者均无复发和转移。结论与VATS经肋间手术比较，VATS剑突下入路手术治疗胸腺瘤减少了手术刨伤，降低了并发症发生率，减轻了患者痛苦，缩短了患者住院时间，疗效更加显著。

Objective To compare the effects of video assisted thoracoscopic surgery（VATS） of intercostal surgery and by subxiphoid surgical treatment for early thymoma, to investigate the feasibility and clinical application value of VATS subxiphoid surgical treatment for thymoma. Methods From January 2014 to January 2017,30 thymoma patients who met the diagnostic criteria of the Masaoka stage Ⅰ - Ⅱ in the People＇s Hospital of Jingshan County were selected,and were divided into two groups according to the different surgical methods. The observation group （12 patients） received VATS underwent subxiphoid surgery, 18 patients in the control group were treated with VATS intercostal surgery. The operation time, blood loss, drainage time, length of stay, degree of pain, antibacterial time, incidence rate of complication and patients＂ satisfaction were compared between the two groups. Results The preoperative general data between the two groups had no statistically significant differences （all P 〉 0.05）. The operation time, intraoperative bleeding volume, postoperative drainage time, antibacterial time, postoperative hospitalization time in the observation group were （ 102.2 ±26.6） min, （ 105.9 ±29.4） mL, （ 3.8 ±1.4） d, （6. 8 ±0. 3 ） d, （ 8.5 ±1.6） d, respectively, which in the control group were （ 124.6 ±35.1 ） min, （255.6 ±82.8） mL, （5.2 ±1.2） d, （9.3 ±0.8 ） d, （ 14.4 ±1. 8）d, respectively, there were statistically significant differences between the two groups （t = 1.516,2.517,2. 857, 4. 462,3. 327, all P 〈 O. 05 ）. The incidence rate of complications （8.33% vs. 16.67% ）, satisfaction （82% vs. 59% ） between the two groups had statistically significant differences （ X2 = 4.013,4.427, all P 〈 O. 05）. During the follow - up period,there was no recurrence or metastasis in the two groups. Conclusion Compared with VATS intercostal surgery, VATS subxiphoid approach for surgical treatment of thymoma can reduce surgical trauma and reduce the incidenee of complieations, reduce the pain of patients, shorten the hospitalization time,its curative effect is more significant.