经剑突下胸腔镜前纵隔肿瘤切除术疗效及远期疼痛分析  

Analysis of clinical effect and postoperative long-term pain after subxiphoid thoracoscopic anterior mediastinal tumor resection

作　　者：李子凡 龙飞虎 乌达[1] 牟志民[1] 刘继先[1] 毛海龙 吴昊[1] Li Zifan;Long Feihu;Wu Da;Mu Zhiming;Liu Jixian;Mao Hailong;Wu Ha(Department of Thoracic Surgery,Peking University Shenzhen Hospital,Clinical College of Anhui Medical University,Guangdong518036,China)

机构地区：[1]安徽医科大学北大深圳医院临床学院胸外科,518036

出　　处：《山西医药杂志》2021年第3期360-363,共4页Shanxi Medical Journal

摘　　要：目的该研究旨在通过回顾性分析北京大学深圳医院接受前纵隔肿瘤切除的患者,运用倾向性评分匹配(PSM)等方法,比较经剑突下入路与经侧胸入路行前纵隔肿瘤切除的疗效和术后远期疼痛。方法2015年2月至2018年9月,北京大学深圳医院胸外科共167例患者接受胸腔镜前纵隔肿瘤切除术。其中42例(25.1%)接受经剑突下入路手术,125例(74.9%)接受经侧胸入路手术。于2019年1月进行电话随访,疼痛程度以疼痛数字评分(NRS)表示,随访日期距手术日期间隔的中位时间为33.6个月。在两手术组之间进行倾向性评分匹配,在匹配组间比较两组手术的疗效与术后远期疼痛程度。结果随访期间2组患者均无新发重症肌无力(MG)、肿瘤复发或死亡。在两组间进行1∶1倾向性评分匹配后组间人口基线特征变量差异无统计学意义(P>0.05),经剑突入路与经侧胸入路组各42例患者入组。经侧胸入路组与剑突下入路组在术中出血、手术时长、术后感染等方面差异无统计学意义(P>0.05)。2组患者的术后远期NRS评分差异无统计学意义(P>0.05)。结论经剑突下胸腔镜前纵隔肿瘤切除是一种安全可行的术式,与经侧胸入路手术疗效相当。然而在我们的研究中,剑突下组相比于侧胸组在减轻术后远期疼痛方面没有观察到明显的优势。Objective To compare the clinical efficacy and postoperative long-term pain between subxiphoid approach and lateral intercostal approach,using propensity score matching(PSM)and some other methods,through a retrospective analysis of patients underwent anterior mediastinal tumor resection in Peking University Shenzhen Hospital.Methods A total of 167 patients underwent anterior mediastinal tumor resection from February 2015 to September 2018 in the Department of Thoracic Surgery,Peking University Shenzhen Hospital,and 42(25.1%)patients received subxiphoid approach surgery,125(74.9%)patients received lateral intercostal approach surgery.The postoperative telephone follow-up was conducted in January 2019,and the Numeric Rating Scale(NRS)was used to score postoperative long-term pain.The average interval time between the follow-up date and the operation date was 33.6 months.The clinical efficacy and postoperative long-term pain were compared after PSM between the two groups.Results There was no new myasthenia gravis(MG),tumor recurrence or death in both groups during the follow-up period.After PSM,42 pairs of patients were 1∶1 matched in the two groups and all baseline characteristics were well balanced(P>0.05).There was no statistically significant difference in intraoperative blood loss,operation time and postoperative infection between the subxiphoid and the lateral intercostal groups(P>0.05).The NRS score of postoperative long-term pain was similar between the two groups(P>0.05).Conclusions Thoracoscopic surgery through subxiphoid is a safe and feasible approach,the clinical efficacy is comparable with the lateral intercostal approach.However,no significant advantage of postoperative long-term pain relief is observed in subxiphoid group in our study.

关 键 词：纵隔肿瘤 剑突下入路 胸腔镜检查 疼痛数字评分 

分 类 号：R734.5[医药卫生—肿瘤]