剑突下胸腔镜前纵隔肿瘤切除术初步应用分析

A preliminary application analysis of the subxiphoid approach in video-assistedthoracoscopicresection of anterior mediastinal tumor

目的探讨剑突下胸腔镜前纵隔肿瘤切除术的临床应用价值。方法2016年1月至2019年6月,对收治的前纵隔肿瘤患者23例行手术治疗,其中行单侧胸腔镜手术18例(对照组),行剑突下胸腔镜手术5例(研究组)。结果两组患者均按预定方式顺利完成手术,其中研究组1例出现纵隔肿瘤侵犯左上肺,同时行左上肺楔形切除术。两组患者的术中出血量、住院时间、术后引流管留置时间均无明显差异(P>0.05),手术时间有明显差异(P<0.05),术后24h疼痛评分有明显差异(P<0.05)。患者均无术后出血二次开胸手术,对照组1例出现术后左侧眼睑下垂,随访后有好转。结论剑突下胸腔镜前纵隔肿瘤切除术安全、可行,具有明显优势,值得推广、普及。

Objective To evaluate the clinical value of subxiphoid approach in video-assistedthoracoscopicresection of anterior mediastinal tumor.Methods From January 2016 to June 2019,23 patients with anterior mediastinal tumor all underwent thoracoscopic tumorresection surgeries,among which 18 patients received unilateral thoracoscopic surgery(control group)and 5 patients received subxiphoidthoracoscopic surgery(research group).Results All the patients in the two groups successfully completed the operation according to their predetermined method.One case in the research group suffered mediastinal tumorsencroaching on the left upperlung,and wedge resection of the left upper lung was performed at the same time.There was no significant difference in intraoperative blood loss,length of hospital stay,and drainage tube indwelling time between the two groups(P>0.05),however,there were significant differences in operative time(P<0.05),and postoperative pain score at 24 h(P<0.05).None of the patients underwent postoperative bleeding and secondary thoracotomy,and one patient in the control group got postoperative left eyelid droop,whichimproved after follow-up.Conclusions The subxiphoid approach in video-assistedthoracoscopicresection of anterior mediastinal tumor is safe,feasible and has obvious advantages and shall be popularized.