经剑突下切口和肋间切口胸腔镜前纵隔肿瘤切除术临床对比研究  

Clinical comparison study of VATS anterior mediastinal tumor resection through approach of trans-subsagittal incision and trans-intercostal incision

作　　者：郭清奎[1] 郑敏[1] 徐烨[1] 钱文良[1] 朱辰[1] 王宁 赵闻 Guo Qingkui;Zheng Min;Xu Ye;Qian Wenliang;Zhu Chen;Wang Ning;Zhao Wen(Department of Thoracic Surgery,Tongren Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200336,China)

机构地区：[1]上海交通大学医学院附属同仁医院,200336

出　　处：《中华胸心血管外科杂志》2020年第11期656-659,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：上海市长宁区卫健委长宁区医学名专科(YXMZK008)。

摘　　要：目的比较经剑突下切口和经肋间切口两种不同手术入路胸腔镜(video assisted thoracoscopic surgery,VATS)前纵隔肿瘤切除术的临床效果。方法回顾性分析上海交通大学医学院附属同仁医院胸外科2013年1月至2020年10月收治的行VATS前纵隔肿瘤切除术患者118例,男67例,女51例。根据切口入路不同分为两组:经剑突下切口组45例,男25例,女20例;经肋间切口组73例,男42例,女31例。经剑突下切口组应用剑突下切口加肋弓下切口以及应用胸骨拉钩牵引胸骨术式;经肋间切口组应用传统胸壁肋间隙切口术式。比较两组患者手术时间、术中出血量、中转开胸比例、术后胸腔引流管留置时间、术后第1和第3天视觉模拟评分法(visual analogy score,VAS)评分、住院时间、住院费用及术后并发症等临床指标。结果经剑突下切口组手术时间、术中出血量、中转开胸例数、术后胸腔引流管留置时间、术后第1和第3天VAS评分、住院时间、住院费用及术后并发症发生率均低于经肋间切口组(P<0.05)。结论经剑突下切口加肋弓下切口及应用胸骨拉钩牵引胸骨术式较经肋间切口术式VATS切除前纵隔肿瘤的手术时间短,术中出血量少,无中转开胸,操作更简单安全,患者创伤小,术后疼痛轻,并发症少,住院时间短,住院费用少,康复快速。Objective To compare the clinical effect of anterior mediastinal tumor resection with video assisted thoracoscopic surgery(VATS)through approach of trans-subsagittal incision and trans-intercostal incision.Methods The clinical data of 118 patients including 67 males and 51 females with anterior mediastinal tumors using VATS resection from January 2013 to October 2020 in Tongren Hospital,Shanghai Jiao Tong University School of Medicine were analyzed retrospectively.According to different incisional approach,these patients were divided into two groups of trans-subsagittal incision group including 45 cases with 25 males and 20 females,and trans-intercostal incision group including 73 cases with 42 males and 31 females.The sternal incision group was treated with the sub xiphoid incision plus the subcostal arch incision and the sternal retractor traction sternum,and the intercostal incision group was treated with the traditional intercostal space incision.Subsagittal incision combined subcostal arch incision and sternum traction with sternal retractor was used in the approach of trans-subsagittal incision group,and the traditional thoracotomy was used in the intercostal incision group.The clinical data of operation time,volume of intraoperative blood loss,rate of transfer to open thoracotomy,duration of postoperative chest tube drainage,visual analogy score(VAS)assessed on the 1st and 3rd days after surgery,hospitalization time,average cost of hospitalization,and incidence of postoperative complications,were compared between the two groups.Results The operative time,volume of intraoperative blood loss,the number of cases of transfer to open thoracotomy,duration of postoperative chest tube drainage,VAS score of the first and third days after operation,length of hospitalization,average hospitalization cost and the incidence of postoperative complications were lower than those in the transcostal incision group(P<0.05).Conclusion Compared to the group of trans-intercostal incision VATS resection of anterior mediastinal tu

关 键 词：纵隔肿瘤 电视辅助胸腔镜手术 经剑突下切口 经肋间切口 视觉模拟评分法 

分 类 号：R734.5[医药卫生—肿瘤]