剑突下单孔胸腔镜技术治疗前纵隔肿瘤与传统外科手术方法的效果比较  

Comparative analysis of xiphoid single hole video-assisted thoracoscopic surgery in the treatment of anterior mediastinal tumor with traditional surgical method

作　　者：祝沪军[1] 王岳峰[1] 杨鹏[1] 郭德庆[1] 张振才[1] 马宪友[1] 杨雪峰[1] 孙涛[1] 石磊[1] ZHU Hu-jun;WANG Yue-feng;YANG Peng;GUO De-qing;ZHANG Zhen-cai;MA Xian-you;YANG Xue-feng;SUN Tao;SHI Lei(Department of Cardiothoracic Surgery,General Hospital of Daqing Oil Field,Daqing 163001,China)

机构地区：[1]大庆油田总医院胸心外科,黑龙江大庆163001

出　　处：《哈尔滨医科大学学报》2018年第2期163-166,169,共5页Journal of Harbin Medical University

摘　　要：目的对比分析经剑突下单孔胸腔镜前纵隔肿瘤切除与正中胸骨锯开及经侧胸壁胸腔镜前纵隔肿瘤切除患者的临床资料,探讨各术式优缺点,指导临床应用。方法收集自2012年1月~2017年10月本院应用剑突下单孔胸腔镜法、正中胸骨锯开法、经侧胸壁胸腔镜法的前纵隔肿瘤切除患者124例,其中正中胸骨锯开组42例,经侧胸壁胸腔镜组41例,剑突下单孔胸腔镜组41例,对比分析各组肿瘤性质、肿瘤直径、手术时间、术中失血量、术后引流量、插管时间、ICU停留时间、术后住院时间、术后镇痛药物使用时间、相关并发症发生情况等资料。结果全部病例无住院死亡,均痊愈出院。剑突下单孔胸腔镜组在术后引流量、引流管留置时间、术后住院时间、术后镇痛药物使用时间、留置引流管比例等方面明显优于正中胸骨锯开组和经侧胸壁胸腔镜组(均P <0. 05),而在肿瘤类型、肿瘤直径、手术时间、ICU停留时间、术后肺水肿、肺不张、伤口愈合、咳嗽咳痰、伤口愈合不良、呼吸功能不全、胸腔纵隔积气积液等方面与其他二组差异无统计学意义(P> 0. 05)。结论剑突下单孔胸腔镜技术对比正中胸骨锯开及经侧胸壁胸腔镜前纵隔肿瘤切除技术在治疗效果良好的同时创伤更小,恢复更快,值得推广应用。Objective To explore the advantages and disadvantages of each operation and to guide the clinical application, through the comparative analysis of the clinical data of single xiphoid hole thoracoscopic anterior mediastinal tumor resection and sternotomy and lateral tho- racic through wall thoracoscopic anterior mediastinal tumor resection. Methods From January 2012 to October 2017 in the hospital, 124 cases of anterior mediastinal tumor resection were performed with xiphoid single hole thoracoscopic method, median sternotomy method, the later- al chest wall by thoracoscopic method, 56 cases were male and 68 were female, the median age was （54. 55± 12. 88 ） years（ range 17 ~ 78 years）. The xiphoid single hole video-assisted tho- racoscopic surgery was performed in 41 cases, median sternotomy sternum saw was performed in 42 cases, the lateral chest wall VATS was performed in 41 cases. The blood tumor characteristics, tumor size, operative time, intraoperative and postoperative drainage volume, intuba- tion time, ICU stay time, postoperative hospital stay, analgesic drug use time, complication rate and other data were comparative analyzed. Results There were no hospital deaths and all patients were discharged from hospital. There was no significant difference in tumor type, tumor size, operation time, intubation time, ICU stay time, postoperative pulmonary edema, atelecta- sis, wound healing, cough and expectoration, impaired wound healing, good respiratory func- tion the whole, pleural pneumomediastinum effusion with xiphoid single hole thoracoscopic group and median steruotomy group and the lateral chest wall thoracoscopic group （ P 〉 0.05 ）, whereas the intraoperative blood loss, postoperative drainage, drainage tube indwelling time, postoperative hospitalization time, postoperative analgesic use time, pulmonary infection in sin- gle hole group was significantly better than the other two groups （ P 〈 0.05 ）. Conclusion Xiphoid single hole VATS in treatment of anterior mediastinal tumor resect

关 键 词：胸腔镜检查 前纵隔肿瘤 外科手术治疗 剑突下 单操作孔 

分 类 号：R655.5[医药卫生—外科学]