截石位经剑突下入路与侧卧位经肋间入路胸腔镜下前纵隔肿物切除术的临床分析

Clinical analysis of thoracoscopic anterior mediastinal tumor resection in lithotomy position via subxiphoid approach or lateral position via transthoracic approach

目的探讨截石位经剑突下入路及侧卧位经肋间入路胸腔镜下前纵隔肿物切除术的安全性、可行性及近期临床疗效。方法回顾性分析2016年3月至2018年5月兰州大学第一医院胸外科前纵隔肿瘤44例患者的临床资料,其中21例行截石位经剑突下入路前纵隔肿物切除术(截石位经剑突下组),男10例、女11例,年龄(43.6±11.8)岁;23例行侧卧位经肋间前纵隔肿物切除术(对照组),男13例、女10例,年龄(45.3±10.8)岁。比较两组临床效果。结果截石位经剑突下组术后胸腔引流时间[(3.8±1.3)d vs.(5.0±1.8)d,P=0.017]、术后引流量[(238.8±66.2)mL vs.(467.2±120.0)mL,P=0.000]、术后24 h平均视觉模拟评分[(2.5±0.9)分vs.(4.9±1.0)分,P=0.000]、自主按压镇痛泵次数[(3.7±0.9)次vs.(8.4±2.0)次,P=0.000]、术后住院时间[(4.7±1.3)d vs.(7.4±3.1)d,P=0.000]及住院费用[(3.4±0.8)万元vs.(4.4±1.1)万元,P=0.001]均优于对照组,两组手术时间[(59.0±18.1)min vs.(60.4±16.4)min]差异无统计学意义(P>0.05)。随访期间,两组患者均无复发和转移。结论与侧卧位经肋间入路相比,截石位经剑突下入路胸腔镜下前纵隔肿物切除术安全可行,并具有一定的优越性。

Objective To discuss the safety,feasibility and short-term clinical efficacy of thoracoscopic anterior mediastinal mass resection in lithotomy position via subxiphoid approach or lateral position via transthoracic approach.Methods A total of 44 patients suffering anterior mediastinal tumor enrolled,including 21 patients(10 males and 11 females as a trial group)with an average age of 43.6±11.8 years who have been performed thoracoscopic anterior mediastinal tumor resection in lithotomy position via subxiphoid approach and 23 patients(13 males and 10 females as a control group)with an average age of 45.3±10.8 years who have been performed thoracoscopic anterior mediastinal tumor resection in lateral position via transthoracic approach.The clinical efficacy of the two groups was compared.Results Postoperative chest drainage time(3.8±1.3 d vs.5.0±1.8 d,P=0.017),postoperative drainage volume(238.8±66.2 mL vs.467.2±120.0 mL,P=0.000),postoperative mean visual analogue score at 24 h(2.5±0.9 point vs.4.9±1.0 point,P=0.000),times of selfpressure analgesic pump(3.7±0.9 vs.8.4±2.0,P=0.000),duration of postoperative hospital stay(4.7±1.3 d vs.7.4±3.1 d,P=0.000)and hospitalization cost(34±8 kyaun vs.44±11 kyuan P=0.001)in the trial group were all better than those in the control group.There was no significant difference between the two groups in surgical duration(59.0±18.1 min vs.60.4±16.4 min)(P>0.05).During follow-up,no recurrence or metastasis occurred in either group.Conclusion Compared with the lateral position through the transthoracic approach,the lithotomy position through subxiphoid approach of thoracoscopic anterior mediastinal mass resection is safe and feasible,and has certain advantages.