经剑突下与经肋间切口胸腔镜前纵隔病变切除临床疗效

Thoracoscopic surgery for anterior mediastinal lesions:subxiphoid vs.intercostal approach

目的比较胸腔镜经剑突下切口和经肋间切口两种不同手术入路治疗前纵隔病变的临床效果。方法回顾分析宜昌市中心人民医院2020年1月至2021年5月前纵隔手术连续病例,根据切口入路不同分成两组:经剑突下切口组(SAT)63例中男31例,女32例;经肋间切口组(IAT)61例中男25例,女36例。比较两组患者手术时间、术中出血量、中转开胸比例、放置引流管比例、术后炎症指标(白细胞计数和CRP值)、术后引流量、引流管拔除时间、术后第1天疼痛视觉模拟评分(VAS评分)、住院时间、住院费用及并发症等指标。结果两组患者术中出血量、术后引流量、拔管时间、中转开胸率、术后炎症指标(白细胞计数和CRP值)、住院时间、住院费用及并发症均无显著差异。剑突下入路手术时间长于经肋间入路组[(100.9±43.0)min vs.(79.8±47.9)min,t=2.59,P=0.011],剑突下入路组术后VAS疼痛评分、放置引流管比例明显低于经肋间入路组[术后第1天VAS评分:(3.1±0.8)vs.(4.3±0.7),t=-8.839,P<0.001;放置引流管比例:36/63(57.1%)vs.59/61(96.7%),χ^(2)=27.10,P<0.001]。结论经剑突下入路及经肋间入路胸腔镜两种方法治疗前纵隔病变都是安全、有效的。经剑突下入路由于不损伤肋间神经,术后疼痛评分更低,术后可不常规放置引流管,是前纵隔手术更值得推广的入路。

Objective To compare the clinical effects of the subxiphoid approach and the intercostal approach for thoracoscopy for anterior mediastinal lesions.Methods Consecutive patients with anterior mediastinal surgery from January 2020 to May,2021 at Yichang Central People’s Hospital were retrospectively enrolled in the study.A total of 124 cases were included in the study.Sixty-three patients received the thoracoscopy via subxiphoid approach were assigned as one group and the other 61 via the intercostal approach as the other group.The clinical,pathological,and perioperative data of the two groups were collected.Statistical analyses were performed using SPSS version 22.0.Results There were no significant differences in blood loss,drainage volume,time of drainage intubation,conversion rate to thoracotomy,white blood cell value and CRP value after operation,length of hospital stay,hospitalization cost and complications between the two groups.The operation time of the subxiphoid approach group was higher than the intercostal approach group(P<0.05).VAS score and ratio of drainage intubation in the subxiphoid approach group were significantly lower than those in the intercostal approach group(P<0.01).Conclusion Both approaches for thoracoscopy are safe and effective in treating anterior mediastinal lesions.The subxiphoid approach is superior to the intercostal approach for its less damage to the intercostal nerve,less pain,no need for drainage intubation,thereby worthy of spreading clinically.