剑突下入路单孔胸腔镜与三孔胸腔镜纵隔肿瘤切除术临床疗效对比研究

Clinical comparison of single-port thoracoscopy and three-port thoracoscopic mediastinal tumor resection with subxiphoid approach

目的:对比研究剑突下入路单孔胸腔镜纵隔肿瘤切除术与三孔胸腔镜纵隔肿瘤切除术的临床应用效果。方法:选取接受胸腔镜纵隔肿瘤切除术的59例患者,根据手术方式不同分为两组,观察组采用剑突下入路单孔胸腔镜纵隔肿瘤切除术,对照组采用传统三孔胸腔镜纵隔肿瘤切除术;观察两组围手术期指标、血清致痛介质水平及术后并发症情况。结果:观察组术中出血量、术后镇痛次数均少于对照组,术后引流时间、住院时间均短于对照组,两组比较差异有统计学意义(均P<0.05);两组术后血清缓激肽(BK)、5-羟色胺(5-HT)、神经肽Y(NPY)和前列腺素E2(PGE2)等疼痛应激指标水平较术前显著升高,且对照组显著高于观察组,两组比较差异有统计学意义(均P<0.05);两组术后并发症总发生率比较差异无统计学意义(P>0.05);两组术后5年累积无病生存率比较差异无统计学意义(P>0.05)。结论:剑突下入路单孔胸腔镜纵隔肿瘤切除术相比传统三孔胸腔镜手术,具有术中出血少、术后疼痛轻、引流时间和住院时间短等优势,更益于患者术后恢复,是一种安全可行的手术方法。

Objective:To compare the clinical application effect of subxiphoid approach single-port thoracoscopic mediastinal tumor resection and three-port thoracoscopic mediastinal tumor resection.Methods:A total of 59 patients who underwent thoracoscopic mediastinal tumor resection were selected and divided into two groups according to different surgical methods.The observation group underwent single-port thoracoscopic mediastinal tumor resection with subxiphoid approach,and the control group underwent traditional three-port thoracoscopic mediastinal tumor resection.The perioperative indexes,serum pain-causing mediator levels and postoperative complications of the two groups were observed.Results:Intraoperative blood loss and postoperative analgesia times in the observation group were less than those in the control group,postoperative drainage time and hospitalization time were shorter than those in the control group(all P<0.05).The levels of pain stress indexes such as BK,5-HT,NPY and PGE2 in both groups were significantly increased after operation,and the control group was significantly higher than the observation group(all P<0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(P>0.05).There was no significant difference in 5-year cumulative disease-free survival between the two groups(P>0.05).Conclusion:Compared with traditional three-port thoracoscopic surgery,subxiphoid single-port thoracoscopic mediastinal tumor resection has the advantages of less intraoperative bleeding,light postoperative pain,short drainage time and hospital stay,etc.,which is more conducive to postoperative recovery and is a safe and feasible surgical method.