经剑突下入路与经侧胸入路在胸腔镜前纵隔肿瘤切除术中的应用效果及对近期预后的影响

Application effect of subxiphoid approach and lateral thoracic approach in thoracoscopic anterior mediastinal tumor resection and the influences on short-term prognosis

目的分析前纵膈肿瘤切除术不同临床入路治疗方案对患者治疗效果及近期预后的影响。方法将我院2021年1月至2022年8月收治的80例前纵膈肿瘤患者作为研究对象,以治疗方案差异将其分为对照组(40例,经侧胸入路胸腔镜切除术)和研究组(40例,经剑突下入路胸腔镜切除术)。比较两组的治疗效果。结果两组的手术时间、术中出血量无明显差异(P>0.05);研究组的引流时间、术后拔管时间、术后首次下地时间及住院时间均短于对照组(P<0.05)。术前,两组的5-羟色胺(5-HT)、神经肽Y(NPY)、C原反应蛋白(CRP)、白细胞(WBC)水平及中性粒细胞比例无明显差异(P>0.05);术后3 d,研究组的5-HT、NPY、CRP、WBC水平及中性粒细胞比例低于对照组,差异具有统计学意义(P<0.05)。研究组的膈神经波动显著高于对照组,术后并发症总发生率显著低于对照组,差异具有统计学意义(P<0.05)。结论经剑突下入路胸腔镜前纵膈肿瘤切除术能够获得良好的临床治疗效果,保护膈神经,且疼痛程度及炎性反应轻,术后恢复快,利于改善患者预后。

Objective To analyze the influence of different clinical approaches in anterior mediastinal tumor resection on the treatment effects and short-term prognosis of patients.Methods A total of 80 patients with anterior mediastinal tumors admitted in our hospital from January 2021 to August 2022 were selected as the research objects.The patients were divided into control group(40 cases,thoracoscopic resection via lateral thoracic approach)and study group(40 cases,thoracoscopic resection via subxiphoid approach).The therapeutic effects of the two groups were compared.Results There were no significant differences in operation time and intraoperative blood loss between the two groups(P>0.05);the drainage time,postoperative extubation time,postoperative first ambulation time and hospitalization time of the study group were shorter than those of the control group(P<0.05).Before operation,there were no significant differences in the levels of 5-hydroxytryptamine(5-HT),neuropeptide Y(NPY),C-reactive protein(CRP),white blood cell(WBC)and neutrophil ratio between the two groups(P>0.05);at 3 d after operation,the levels of 5-HT,NPY,CRP,WBC and neutrophil ratio in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).The phrenic nerve fluctuation in the study group was significantly higher than that in the control group,the total incidence of postoperative complications was significantly lower than that in the control group,and the differences were statistically significant(P<0.05).Conclusion Thoracoscopic anterior mediastinal tumor resection via subxiphoid approach can obtain good clinical treatment effect and protect the phrenic nerve,with light pain inflammatory reaction and fast postoperative recovery,which is beneficial to improving the prognosis of patients.