超声刀与电凝钩辅助胸腔镜手术治疗纵隔肿瘤的临床效果比较

Comparison of the effect of ultrasonic knife and electrocoagulation hook assisted thoracoscopic surgery for mediastinal tumors

目的探讨超声刀与电凝钩辅助胸腔镜下手术治疗纵隔肿瘤的临床效果。方法采用随机数字表法将90例纵隔肿瘤患者分为超声刀组和电凝组,每组45例,超声刀组患者胸腔镜手术术中采用超声刀进行止血,电凝组患者胸腔镜手术术中采用电凝钩进行止血。比较两组患者围手术期相关指标、炎性因子水平[血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、皮质醇、白细胞计数、中性粒细胞计数]、疼痛程度和并发症发生情况。结果超声刀组患者的术中出血量明显低于电凝组患者,关闭胸腔时间、术后拔管时间均明显短于电凝组患者,差异均有统计学意义(P﹤0.05)。术后12 h,CRP、IL-6、IL-8、TNF-α、皮质醇水平和白细胞、中性粒细胞计数均高于本组术前,且超声刀组患者IL-6、IL-8、TNF-α、皮质醇水平均低于电凝组患者,差异均有统计学意义(P﹤0.05)。两组患者的视觉模拟评分法(VAS)评分及并发症总发生率比较,差异均无统计学意义(P﹥0.05)。结论胸腔镜手术治疗纵隔肿瘤术中采用超声刀止血的效率更高,可进一步降低出血量,减轻炎性反应程度。

Objective To explore the effect of ultrasonic scalpel and electrocoagulation hook assisted thoracoscopic surgery for mediastinal tumors.Method A total of 90 patients with mediastinal tumors were selected as the research objects and were divided into an ultrasonic knife group and an electrocoagulation group,45 cases in each group.The ultrasonic knife group used ultrasonic knife to control bleeding during thoracoscopy while the electrocoagulation group used electrocoagulation hook to stop bleeding.The perioperative indicators,levels of inflammatory factors[serum C-reactive protein(CRP),interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α),cortisol,white blood cell(WBC)count,neutrophils count],the grade of pain and complications were compared between the two groups of patients.Result The intraperative blood loss in the ultrasonic knife group was significantly lower than that in the electrocoagulation group,and the time to close the incisions and the time of postoperative extubation were significantly shorter than those in the electrocoagulation group,the differences were statistically significant(P<0.05).At 12 hours after surgery,the proportions of CRP,IL-6,IL-8,TNF-α,cortisol levels,and WBC,neutrophils count were all higher than those before surgery in this group,and the levels of IL-6,IL-8,TNF-αand cortisol were lower than those in the electrocoagulation group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the total incidence of complications in the visual analogue scale(VAS)score between the two groups(P>0.05).Conclusion The employment of ultrasonic scalpel to stop bleeding during thoracoscopic surgery for mediastinal tumors is more efficient,which can further reduce the volume of bleeding and reduce the degree of inflammatory status.