胸腔镜经剑突下及双侧肋弓下治疗纵隔肿瘤的应用研究  

Application of thoracoscopic surgery for mediastinal tumor with subxiphoid and bilateral costal arches approach

作　　者：王洪 曾小飞[1] 贾维坤[1] 马瑞东[1] 伍志强 何东升[1] 何小平[1] 陆宇海 WANG Hong;ZENG Xiao-fei;JIA Wei-kun;MA Rui-dong;WU Zhi-qiang;HE Dong-sheng;HE Xiao-ping;LU Yu-hai(Department of Cardiothoracic Surgery,First Affiliated Hospital of Chengdu Medical College,Chengdu Sichuan 610500,China)

机构地区：[1]成都医学院第一附属医院胸心外科,四川成都610500

出　　处：《局解手术学杂志》2020年第9期730-733,共4页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨胸腔镜经剑突下及双侧肋弓下行纵隔肿瘤切除术的临床价值。方法回顾性分析我院2017年1月至2019年12月收治的98例纵隔肿瘤患者的临床资料,根据手术入路分为观察组50例(剑突下及双侧肋弓下入路)和对照组48例(侧胸壁入路)。比较2组患者的手术时间、术中失血量、引流管留置时间、住院时间等情况。比较2组患者术前及术后3 d疼痛程度,血清P物质(SP)、五羟色胺(5-HT)、去甲肾上腺素(NE)等疼痛介质水平,血清白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)等炎症因子水平及术后并发症发生率情况。结果观察组患者手术时间、术中失血量、引流管留置时间、住院时间短/少于对照组,差异有统计学意义(P<0.05)。2组患者术前VAS评分及SP、5-HT、NE、IL-6、hs-CRP、TNF-α水平比较,差异无统计学意义(P>0.05);术后3 d,观察组患者VAS评分、SP、5-HT、NE、IL-6、hs-CRP、TNF-α水平及术后并发症发生率均低于对照组,差异有统计学意义(P<0.05)。结论胸腔镜经剑突下及双侧肋弓下纵隔肿瘤切除术具有创伤小、恢复快、安全等优势,可减少术后炎症因子及疼痛介质分泌,缓解患者术后疼痛,且术后并发症发生率低。Objective To explore the clinical value of subxiphoid and bilateral costal arches approach under thoracoscopy for mediastinal tumors.Methods The clinical data of 98 patients with mediastinal tumors admitted to our hospital from January 2017 to December 2019 were retrospectively analyzed.According to the surgical approach,they were divided into in the observation group(50 cases with subxiphoid and bilateral costal arches approach)and the control group(48 cases with lateral chest wall approach).The operation time,intraoperative blood loss,drainage tube retention time,hospitalization days between the two groups were observed.Preoperative and postoperative 3 days,the pain degree,the serum levels of pain mediators such as substance P(SP),5-hydroxytryptamine(5-HT)and norepinephrine(NE),the levels of serum inflammatory factors such as interleukin-6(IL-6),hypersensitive C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),and the postoperative complications between the two groups were compared.Results The operation time,intraoperative blood loss,drainage tube retention time,hospitalization days in the observation group were shorter/less than those in the control group,the differences were statistically significant(P<0.05).There was no significant difference in VAS scores and serum levels of SP,5-HT,NE,IL-6,hs-CRP,TNF-αbetween the two groups(P>0.05).The VAS score,the serum levels of SP,5-HT,NE,IL-6,hs-CRP,TNF-αand the incidence of postoperative complications on postoperative 3 days in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Thoracoscopic treatment of mediastinal tumors resection with subxiphoid and bilateral costal arches approach has the advantages of less trauma,fast recovery and safety,it can reduce postoperative inflammatory factors and pain mediators levels,relieve postoperative pain,with lower incidence of postoperative complications.

关 键 词：胸腔镜 剑突 双侧肋弓 纵隔肿瘤 疼痛介质 炎症因子 

分 类 号：R734.5[医药卫生—肿瘤]