经剑突下入路与经肋间入路胸腔镜术治疗前纵隔肿瘤的效果差异

Comparison of Surgical Outcomes and Complications of Subxiphoid Thoracoscopic Surgery and Intercostal Thoracoscopic Surgery for Anterior Mediastinal Tumors

目的:探究经剑突下入路与经肋间入路胸腔镜术对前纵隔肿瘤疗效、并发症的影响。方法:选2020年1月至2023年1月于宣城市人民医院行胸腔镜手术的前纵隔肿瘤患者100例,根据其手术入路方式将其分为剑突组(经剑突下入路,60例)、肋间组(经肋间入路,40例)。比较两组患者围术期指标(术中出血量、术后引流量、手术时间、镇痛泵使用次数)、康复指标(引流管滞留时间、术后止痛药使用时间、住院时间)、不同时间段疼痛视觉模拟评分(Visual Analog Scale,VAS)以及术后7、15、30、45d Karnofsky功能状态(Karnofsky Performance Status,KPS)评分、并发症(胸腔积液、气胸、肺不张、肺部感染)发生率。结果:剑突组患者的术中出血量为(24.67±3.21)mL,低于肋间组[(40.13±4.29)mL,P<0.05];术后引流量为(151.95±17.12)mL,低于肋间组[(306.50±30.52)mL,P<0.05];手术时间为(66.00±6.59)min,短于肋间组[(91.65±10.51)min,P<0.05];镇痛泵使用次数为(6.07±1.02)次,低于肋间组[(7.10±1.22)次,P<0.05]。剑突组患者的引流管滞留时间为(17.20±3.19)h,低于肋间组[(21.77±3.97)h,P<0.05];术后止痛药使用时间为(1.85±0.92)d,低于肋间组[(3.10±0.90)d,P<0.05];住院时间为(6.10±1.32)d,低于肋间组[(8.75±1.66)d,P<0.05]。剑突组患者的术前VAS评分为(2.02±0.43)分,与肋间组[(2.00±0.45)分比较无差异,P>0.05];术后1d为(4.57±1.44)分,显著低于肋间组[(5.83±1.48)分,P<0.05];术后2d为(3.00±1.01)分,显著低于肋间组[(4.38±1.39)分,P<0.05];术后3d为(2.40±0.62)分,显著低于肋间组[(3.42±0.81)分,P<0.05]。剑突组患者术后7d的KPS评分为(60.13±3.20)分,显著高于肋间组[(57.38±4.20)分,P<0.05];术后15d为(65.78±3.09)分,显著高于肋间组[(62.17±3.76)分,P<0.05];术后30d为(71.50±3.71)分,显著高于肋间组[(68.10±3.86)分,P<0.05];术后45d为(81.67±5.07)分,显著高于肋间组[(75.45±5.20)分,P<0.05]。并发症总发生率3.33%少于肋间组20.00%,差异有统计学意义(P<0.05)。结论:经剑突下入路胸腔镜术对前纵隔肿瘤治疗效果理想,能够有效改善患者疼痛及功能状态,减少并发症的发生。

Objective:To investigate the surgical outcomes and complications of subxiphoid thoracoscopic surgery and intercostal thoracoscopic surgery for anterior mediastinal tumors.Methods:A total of 100 patients with anterior mediastinal tumors who underwent thoracoscopic surgery at Xuancheng People's Hospital from January 2020 to January 2023 were enrolled in this study.According to the surgical approach,the patients were divided into the subxiphoid group(subxiphoid thoracoscopic surgery,60 cases)and the intercostal group(intercostal thoracoscopic surgery,40 cases).The perioperative indicators(intraoperative blood loss,postoperative drainage volume,operation time,number of pain pump uses),rehabilitation indicators(drainage tube retention time,postoperative analgesic drug use time,hospital stay),different time points of pain visual analog scale(VAS)scores,and postoperative 7,15,30,and 45 days Karnofsky performance status(KPS)scores,and complication rates(pleural effusion,pneumothorax,atelectasis,pulmonary infection)were compared between the two groups.Results:The intraoperative blood loss in the sternotomy group was(24.67±3.21)mL,which was lower than that in the intercostal group[(40.13±4.29)mL,P<0.05];the postoperative drainage volume was(151.95±17.12)mL,which was lower than that in the intercostal group[(306.50±30.52)mL,P<0.05];the operation time was(66.00±6.59)min,which was shorter than that in the intercostal group[(91.65±10.51)min,P<0.05];the number of pain pump uses was(6.07±1.02)times,which was lower than that in the intercostal group[(7.10±1.22)times,P<0.05].The drainage tube retention time in the sternotomy group was(17.20±3.19)h,which was lower than that in the intercostal group[(21.77±3.97)h,P<0.05];the postoperative analgesic drug use time was(1.85±0.92)d,which was shorter than that in the intercostal group[(3.10±0.90)d,P<0.05];the hospital stay was(6.10±1.32)d,which was shorter than that in the intercostal group[(8.75±1.66)d,P<0.05].The VAS scores of patients in the sternotomy group were(2.02±0.43)points before surgery,which were not significantly different from those in the intercostal group[(2.00±0.45)points,P>0.05];the VAS scores were(4.57±1.44)points at 1 day after surgery,which were significantly lower than those in the intercostal group[(5.83±1.48)points,P<0.05];the VAS scores were(3.00±1.01)points at 2 days after surgery,which were significantly lower than those in the intercostal group[(4.38±1.39)points,P<0.05];the VAS scores were(2.40±0.62)points at 3 days after surgery,which were significantly lower than those in the intercostal group[(3.42±0.81)points,P<0.05].The KPS score of subxiphophorus group was(60.13±3.20)points at 7 days after operation,which was significantly higher than that of intercostal group[(57.38±4.20)points,P<0.05].15 days after surgery,the score was(65.78±3.09),significantly higher than that in intercostal group[(62.17±3.76),P<0.05].The score at 30d after operation was(71.50±3.71)points,significantly higher than that in intercostal group[(68.10±3.86)points,P<0.05].The score at 45 days after operation was(81.67±5.07),significantly higher than that in intercostal group[(75.45±5.20),P<0.05].The total incidence of complications was lower than that of intercostal group,the difference was statistically significant(P<0.05).Conclusion:Thoracoscopy via subxiphoid approach is ideal for the treatment of anterior mediastinal tumors,which can effectively improve patients'pain and functional status and reduce the occurrence of complications.