改良模块化剑突下胸腔镜胸腺肿瘤切除术临床应用

Summary of key points and clinical application of modified modular subxiphoid thoracoscopic thymectomy

目的 总结剑突下入路胸腔镜胸腺肿瘤切除术的临床疗效。方法 2021年2月~2023年3月我院行胸腔镜胸腺肿瘤切除术病人93例。按照手术入路分为剑突下组(40例)和侧进胸组(53例)。比较两组手术结果、围术期指标及术后疼痛情况。结果 两组病人均完成胸腔镜胸腺全切或胸腺扩大切除术,无中转开胸。剑突下组胸腺全切手术时间为(60.32±1.53)分钟,胸腺扩大切除手术时间为(114.52±11.63)分钟,术后带管时间为(3.20±0.91)天,术后住院时间为(4.00±0.16)天,侧进胸组分别为(66.62±1.45)分钟、(138.76±6.35)分钟、(4.00±1.22)天和(4.70±0.18)天,两组比较差异有统计学意义(P<0.05)。剑突下组术后24小时VAS评分为(3.8±0.8)分、48小时VAS评分为(3.0±0.7)分、72小时VAS评分为(2.6±0.9)分,侧进胸组分别为(5.7±0.9)分、(4.7±0.8)分和(3.2±0.8)分,两组比较差异有统计学意义(P<0.05)。两组病人术中失血量、住院费用、并发症发生率、术后30天感觉异常情况比较差异无统计学意义(P>0.05)。结论 改良模块化剑突下胸腔镜胸腺肿瘤切除术安全可靠,具备明显的围术期优势,尤其适合伴有重症肌无力的MasaokaⅠ、Ⅱ期胸腺瘤病人。

Objective To summarize the key surgical points of subxiphoid thoracoscopic thymectomy and compare its clinical efficacy with lateral thoracic approach thymectomy.Methods Clinical data of 93 patients who underwent thoracoscopic thymectomy for thymic tumors at Wuhan Tongji Hospital from February 2021 to March 2023 were collected.The patients were divided into the subxiphoid group(n=40)and the lateral thoracic group(n=53)according to the surgical approach.Surgical outcomes,perioperative indicators,and postoperative pain were compared between the two groups.Results Both groups of patients underwent complete or extended thymectomy via thoracoscopy without conversion to open surgery.The subxiphoid group had significantly shorter operation time for complete thymectomy[(60.32±1.53)minutes],operation time for extended thymectomy[(114.52±11.63)minutes],duration of chest tube placement[(3.20±0.91)days],and length of hospital stay[(4.00±0.16)days]compared to the lateral thoracic group[(66.62±1.45)minutes,(138.76±6.35)minutes,(4.00±1.22)days and(4.70±0.18)days,respectively],with statistical significance(P<0.05).The subxiphoid group also had lower VAS scores at 24 hours(3.8±0.8),48 hours(3.0±0.7),and 72 hours(2.6±0.9)postoperatively,compared to the lateral thoracic group[(5.7±0.9),(4.7±0.8),(3.2±0.8),respectively],with statistical significance(P<0.05).There were no significant differences between the two groups in terms of intraoperative blood loss,hospital costs,complication rates,and abnormal sensations after 30 days postoperatively(P>0.05).Conclusion Modified modular subxiphoid thoracoscopic thymectomy is safe and reliable,and offers significant perioperative advantages,especially for patients with Masaoka stage I and II thymomas accompanied by myasthenia gravis(MG).