剑突下入路与侧胸入路电视胸腔镜手术治疗纵隔肿瘤的近期疗效分析

Analysis of shortterm efficacy of videoassisted thoracoscopic surgery for mediastinal tumors via subxiphoid approach and lateral thoracic approach

目的探讨剑突下入路与侧胸入路电视胸腔镜手术治疗纵隔肿瘤的近期疗效。方法选取我院2017年5月—2019年5月收治的126例纵隔肿瘤患者符合本次研究纳、排标准的80例作为研究对象,利用分层随机分组法将其分为对照组和观察组各40例,其中对照组采用侧胸入路电视胸腔镜手术进行治疗,观察组采用剑突下入路手术进行切除,比较两组术中出血量、手术时间、术后住院时间、术后拔管时间、术后胸腔引流量,比较两组的疼痛视觉模拟评分VAS,比较两组术后疼痛及并发症。结果观察组术中出血量(65.23±19.41)mL少于对照组(89.56±12.56)mL(t=6.656,P=0.000),手术时间(133.89±19.67)min短于对照组(134.67±23.56)min(t=2.103,P=0.038),术后胸腔引流量(212.56±61.56)mL少于对照组(265.71±67.21)mL(t=3.688,P=0.001),差异均有统计学意义;术后1天、术后三天、术后五天VAS疼痛评分分别为(3.36±0.46)分、(3.03±0.84)分、(1.91±0.26)分均低于对照组(3.56±0.11)分(t=2.674,P=0.009)、(3.36±0.12)分(t=2.460,P=0.016)、(2.34±0.11)分(t=9.633,P=0.000),差异均有统计学意义(P<0.05);术后并发症总发生率5%低于对照组20%(χ^(2)=4.414,P=0.042),差异有统计学意义。结论剑突下入路手术对于纵隔肿瘤疾病治疗效果显著,可明显减轻术后疼痛、肺不张、肺部感染等相关并发症,值得推广。

Objective To explore the shortterm curative effect of videoassisted thoracoscopic surgery for mediastinal tumors via subxiphoid approach and lateral thoracic approach respectively.Methods A total of 80 cases of 126 patients with mediastinal tumors admitted to our hospital from May 2017 to May 2019 were selected as research objects,and they were divided into a control group and an observation group with 40 cases in each group by stratified random grouping.The control group was treated by videoassisted thoracoscopic surgery through lateral thoracic approach,while the observation group was resected by subxiphoid approach.The intraoperative blood loss,operation time,postoperative hospital stay,postoperative extubation time,postoperative thoracic drainage volume,pain visual analogue scale(VAS),postoperative pain and complications were compared between the two groups.Results The intraoperative blood loss of the observation group was(65.23±19.41)ml less than that of the control group(89.56±12.56)ml(t=6.656,P=0.000),the operation time of the observation group was(133.89±19.67)min shorter than that of control group(134.67±23.56)min(t=2.103,P=0.038),and the postoperative thoracic drainage volume of the observation group was(212.5661.56)shorter than that of the control group(265.71±67.21)ml(t=3.688,P=0.001).The VAS pain scores of the observation group were(3.36±0.46),(3.03±0.84)and(1.91±0.26)on the 1st,3rd and 5th day respectively after the operation,which were lower than those of the control group:(3.56±0.11),(t=2.674,P=0.009),(3.36±0.12),(t=2.460,P=0.016)and(2.34±0.11)(t=9.633,P=0.000).The total incidence of postoperative complications of the observation group was 5%lower than that of the control group(20%,P<0.05).Conclusion The subxiphoid approach is effective in the treatment of mediastinal tumor diseases,and it can obviously reduce postoperative pain,pulmonary atelectasis,pulmonary infection and other related complications,which is worth popularizing.