胸腔镜经剑突下与经侧胸入路行前纵隔肿瘤切除的早期效果比较  

Comparative analysis of short-term outcomes of video-assisted thoracoscopic surgery for anterior mediastinal tumors via subxiphoid and lateral intercostal approaches

作　　者：贺海奇 冯锦腾 范坤 马磊[2] 吴齐飞[1] 王哲[1] 张勇[1] 贾卓奇[1] 温小鹏[1] 张广健[1] 付军科[1] He Haiqi;Feng Jinteng;Fan Kun;Ma Lei;Wu Qifei;Wang Zhe;Zhang Yong;Jia Zhuoqi;Wen Xiaopeng;Zhang Guangjian;Fu Junke(Department of Thoracic Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Shaanxi Xi'an 710061,China;Department of Operation,the First Affiliated Hospital of Xi'an Jiaotong University,Shaanxi Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院胸外科,陕西西安710061 [2]西安交通大学第一附属医院手术部,陕西西安710061

出　　处：《现代肿瘤医学》2020年第15期2614-2617,共4页Journal of Modern Oncology

基　　金：2017年吴阶平医学基金会临床科研专项资助基金(编号:320.2730.1877)。

摘　　要：目的:探讨胸腔镜经剑突下前纵隔肿瘤切除手术的有效性和安全性。方法:收集2015年1月至2018年5月我科行胸腔镜经剑突下和经侧胸入路的前纵隔肿瘤切除患者90例,其中,经剑突下28例,经侧胸62例。比较两组手术时间、术中出血量、术后疼痛评分、术后引流时间、术后住院时间及术后并发症等指标。结果:经剑突下与经侧胸入路的胸腔镜辅助前纵隔肿瘤切除术的手术时间无明显差异,手术切除肿瘤最大直径无明显差异,但经剑突下入路组术中出血量更少(P=0.014),术后24小时疼痛评分比侧胸入路组低(P=0.014);经剑突下与经侧胸入路胸腔引流的时间无明显差异(P=0.09),但经剑突下入路组术后住院时间较经侧胸入路组明显缩短(P<0.01)。经侧胸入路组1例术中中转开胸,术后2例发生肺膨胀不良,经剑突下入路组术后1例发生伤口脂肪液化。两组患者均无30天内死亡和再住院。结论:胸腔镜辅助经剑突下前纵隔肿瘤切除术安全可行,具有出血少、术后恢复快的优势。Objective:To explore the safety and feasibility of video-assisted thoracoscopic surgery for anterior mediastinal tumors via subxiphoid.Methods:Patients who video-assisted thoracoscopic surgery for anterior mediastinal tumors via subxiphoid or lateral intercostal approaches in our hospital between January 2015 and May 2018 were retrospectively analyzed.A total of 90 patients were included for analysis.Of them,28 patients were treated with the subxiphoid approach and 62 patients were treated with the lateral intercostal approach.The operative time,intraoperative blood loss,postoperative pain,duration of chest drainage,postoperative hospital stay and postoperative complications were compared between the two groups.Results:There was no significant difference in the operative time and maximal tumor diameter between the two groups.The intraoperative blood loss was less in the group using the subxiphoid approach compared with the lateral approach(P=0.014).Compared with the lateral approach,the postoperative pain scores was less in the group using the subxiphoid approach(P=0.014),with shorter hospital stay(P<0.01),although the duration of chest drainage was similar between the two groups(P=0.09).In the lateral approach group,one patient experienced conversion to thoracotomy during operation,two patients suffered from atelectasis after operation.In the subxiphoid approach group,one patient suffered from wound fat liquefaction after operation.There were no 30-day mortality and readmission in the two groups.Conclusion:Video-assisted thoracoscopic surgery for anterior mediastinal tumors via subxiphoid is safe and technically feasible,with advantages of decreased blood loss and faster recovery after surgery.

关 键 词：前纵隔肿瘤 剑突下 胸腔镜手术 

分 类 号：R734.5[医药卫生—肿瘤]