剑突下单孔胸腔镜胸腺扩大切除术的学习曲线分析  

An analysis on learning curve of subxiphoid uniportal video-assisted thoracoscopic extended thymectomy

作　　者：张淼[1] 武文斌[1] 杨敦鹏 张辉[1] 胡正群[1] 刘冬[1] 李敏[1] Zhang Miao;Wu Wenbin;Yang Dunpeng;Zhang Hui;Hu Zhengqun;Liu Dong;Li Min(Department of Thoracic Surgery,Xuzhou Central Hospital,Xuzhou 221009,China)

机构地区：[1]徐州市中心医院胸外科

出　　处：《中华胸部外科电子杂志》2019年第3期146-151,共6页CHINESE JOURNAL OF THORACIC SURGERY：Electronic Edition

基　　金：徐州市科技计划资助项目(KC16SH102)

摘　　要：目的探讨剑突下单孔胸腔镜(UVATS)胸腺扩大切除术的学习曲线特点。方法回顾性分析2015年1月—2019年1月在徐州市中心医院同一术者连续开展的胸腺切除并前纵隔脂肪清扫术的病例资料。依据手术先后分为剑突下UVATS-A组(n=15)、UVATS-B组(n=15)和UVATS-C组(n=15)。记录各组患者的手术时间、术中出血量、中转多孔胸腔镜或开胸率、术后胸腔置管时间与总引流量、并发症、疼痛评分和住院时间的差异,与经肋间入路多孔胸腔镜胸腺扩大切除术患者(MVATS组,n=46)进行比较。术后肺CT扫描分析前纵隔脂肪切除是否彻底。结果各组患者年龄、性别构成比、体重指数、肿瘤直径等比较差异均无统计学意义(P>0.05)。MVATS组5例、UVATS-A组2例、UVATS-B组4例合并重症肌无力(MG)。无中转开胸手术或死亡病例。UVATS-A组2例、UVATS-B组1例中转剑突下三孔VATS。MVATS组患者手术时间、术后胸管引流时间、术后住院时间均显著短于UVATS-A、UVATS-B组(P<0.05),但与UVATS-C组比较无统计学差异(P>0.05);MVATS组患者术后第1、3天的疼痛评分与UVATS-A、UVATS-B组比较均无统计学差异(P>0.05),但显著大于UVATS-C组(P<0.05)。各组术中出血量、术后胸管引流量、手术并发症等比较均无统计学差异(P>0.05)。UVATS-B组2例术后出现MG危象,予血浆置换后缓解。术后CT扫描提示UVATS-A组3例、UVATS-B组2例前纵隔少量脂肪影残留。结论剑突下UVATS胸腺扩大切除术学习曲线至少需要累积30例,其近期临床参数与肋间MVATS比较无显著优势。Objective To explore the characteristics of learning curve of subxiphoid uniportal video-assisted thoracoscopic(UVATS)extended thymectomy.Methods Clinical data of consecutive cases undergoing VATS thymectomy and fat tissue dissection by the same surgeon in Xuzhou Central Hospital between January 2015 and January 2019 was retrospectively analyzed.The patients were divided into subxiphoid UVATS-A(15 cases),UVATS-B(15 cases)and UVATS-C(15 cases)groups according to the date of surgery.The operation time,blood loss,the incidence of conversion to multiport VATS or thoracotomy,postoperative chest tube duration and total drainage volume,complications,pain scale,and postoperative hospital stay were recorded,which were compared with those using intercostal multiport VATS procedure(MVATS group,46 cases).Computed tomography was conducted after surgery to evaluate whether the fat tissue in anterior mediastinum was resected radically.Results Significant difference was not indicated among the groups in terms of age,gender,body weight index,diameter of the tumors(P>0.05).There were 5 cases in the MVATS group,2 cases in the UVATS-A group,and 4 cases in the UVATS-B group indicated myasthenia gravis(MG)before surgery.There was no short-term mortality,or conversion to thoracotomy.One patient in UVATS-A group and 2 patients in UVATS-B group converted to subxiphoid MVATS.Besides,the operation time,chest tube drainage duration and postoperative hospital stay of the patients in MVATS group was significantly shorter than that of UVATS-A and UVATS-B group(P<0.05,respectively),but not UVATS-C group(P>0.05).The pain score on 1d and 3d after surgery of the patients in MVATS group were similar to that of UVATS-A and UVATS-B groups(P>0.05,respectively),but they were higher than that of UVATS-C group(P<0.05,respectively).However,these groups indicated similar intraoperative blood loss,postoperative chest drainage volume,and complications(P>0.05,respectively).The UVATS-B group reported 2 cases of MG crisis after surgery,and they recovered after

关 键 词：剑突下 胸腔镜 胸腺切除术 

分 类 号：R73[医药卫生—肿瘤]