剪刀位经剑突下入路与侧卧位经侧胸入路胸腔镜下治疗前纵隔肿瘤的临床分析

Clinical analysis of thoracoscopic treatment for anterior mediastinal tumor via subxiphoid approach under scissors position and lateral thoracic approach under lateral position

目的探讨剪刀位经剑突下入路(SASP)与侧卧位经侧胸入路(LALP)胸腔镜下治疗前纵隔肿瘤的安全性和可行性。方法回顾性分析2016年6月至2019年11月在我院行胸腔镜下前纵隔肿瘤切除的69例患者的临床资料,其中男32例、女37例,年龄(46.38±11.52)岁。比较SASP组(32例)与LALP组(37例)患者的临床效果。结果全组患者无围手术期死亡,无中转开胸。两组在手术时间[(123.34±12.64)min vs.(125.05±17.02)min,P=0.642]、术中失血量[50.00(73.75)mL vs.50.00(80.00)mL,P=0.643]、切除肿瘤直径[(2.75±0.57)cm vs.(2.89±0.45)cm,P=0.787]、住院总费用[3.27(0.53)万元vs.3.29(0.48)万元,P=0.923]方面差异无统计学意义。SASP组在术后置管时间[2.00(1.00)d vs.4.00(1.50)d,P=0.000]、术后胸腔引流量[260.00(200.00)mL vs.400.00(225.00)mL,P=0.031]、术后疼痛评分[2.00(1.00)分vs.4.00(2.00)分,P=0.000]、术后镇痛药物使用时间[1.50(1.00)d vs.3.00(2.00)d,P=0.000]、术后发热时间[1.50(1.00)d vs.2.00(1.00)d,P=0.000]方面均优于LALP组。结论SASP胸腔镜下切除前纵隔肿瘤更加符合微创理念,术后恢复快,能减少患者痛苦并且术后疗效确切,但对于术者经验及技术要求较高,有条件下值得推广。

Objective To investigate the safety and feasibility of thoracoscopic surgery of anterior mediastinal tumors via subxiphoid approach under scissors position(SASP)and lateral thoracic approach under lateral position(LALP).Methods Clinical data of 69 patients who received anterior mediastinal tumor excision surgery in our hospital from June 2016 to November 2019 were retrospectively analyzed,including 32 males and 37 females with an average age of 46.38±11.52 years.The clinical effects of the two groups were compared.Results There was no perioperative death or conversion to thoracotomy.There was no statistically significant difference between the two groups in the operative time(123.34±12.64 min vs.125.05±17.02 min,P=0.642),intraoperative blood loss[50.00(73.75)mL vs.50.00(80.00)mL,P=0.643],tumor diameter(2.75±0.57 cm vs.2.89±0.45 cm,P=0.787)and total hospital expenses[32.70(5.30)thousand yuan vs.32.90(4.80)thousand yuan,P=0.923].However,the postoperative catheterization time[2.00(1.00)d vs.4.00(1.50)d,P=0.000],postoperative drainage[260.00(200.00)mL vs.400.00(225.00)mL,P=0.031],postoperative pain index[2.00(1.00)points vs.4.00(2.00)points,P=0.000],postoperative analgesic time[1.50(1.00)d vs.3.00(2.00)d,P=0.000],postoperative fever time[1.50(1.00)d vs.2.00(1.00)d,P=0.000]in the SASP group were better than those in the LALP group.Conclusion Thoracoscopic surgery via SASP is more suitable for the treatment of anterior mediastinal tumor with rapid postoperative recovery and reduced pain,and the postoperative curative effect is definite.However,there is a high requirement for the surgical experience and techniques.It can be promoted in the clinic.