截石位经剑突下及侧卧位经肋间前胸腔镜手术治疗前纵隔肿瘤的效果及安全性  

Efficacy and safety of anterior mediastinal tumors treated by laparoscopic thoracoscopic surgery under the xiphoid and lateral position

作　　者：吴凯 杨大彬 任强 WU Kai;YANG Dabin;REN Qiang(Department of Cardiothoracic Surgery,Huaibei Miners General Hospital of Anhui,Anhui Province,Huaibei235000,China)

机构地区：[1]安徽省淮北矿工总医院心胸外科,安徽淮北235000

出　　处：《中国医药导报》2021年第5期109-112,共4页China Medical Herald

摘　　要：目的探讨截石位经剑突下及侧卧位经肋间前胸镜手术治疗前纵隔肿瘤的效果及安全性,为患者诊疗提供依据。方法选择2016年5月—2020年6月安徽省淮北矿工总医院心胸外科收治的前纵隔肿瘤患者90例为研究对象,采用随机数字表法分为两组,各45例。对照组采用侧卧位经肋间前纵隔肿物切除术治疗,观察组采用截石位经剑突下入路前纵隔肿物切除术治疗。比较两组手术情况、视觉模拟评分(VAS)、镇痛泵使用次数及术后并发症。结果两组手术时间、出血量、切口长度、术后引流量、引流时间及呼吸机使用时间比较,差异有统计学意义(P<0.05)。整体分析发现:VAS组间比较、时间点比较及交互作用差异均有统计学意义(P<0.05);进一步两两比较,观察组术后3、5 d的VAS均低于对照组(P<0.05);两组术后3、5 d的VAS均低于术后1 d(P<0.05)。观察组镇痛泵使用次数少于对照组,差异有统计学意义(P<0.05)。观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论截石位经剑突下入路胸腔镜手术治疗前纵隔肿瘤的效果理想,促进患者术后快速恢复,缓解疼痛,安全性高。Objective To explore the effect and safety of anterior mediastinal tumors treated by laparoscopic thoracoscopic surgery under the xiphoid and lateral position,and provide basis for diagnosis and treatment of patients.Methods Ninety patients with anterior mediastinal tumors admitted to Department of Cardiothoracic Surgery of Huaibei Miners General Hospital in Anhui Province from May 2016 to June 2020 were selected as research objects,and they were divided into two groups according to random number table method,with 45 cases in each group.Control group was treated with lateral decubitus anterior mediastinum tumor resection,and observation group was treated with anterior mediastinum tumor resection through the subxiphoid approach in lithotomy position.The operation condition,visual analogue score(VAS),the time of using analgesic pump and postoperative complication were compared between two groups.Results There were significant differences in operation time,blood loss,incision length,postoperative drainage volume,drainage time and ventilator use time between two groups(P<0.05).Overall analysis showed that there were significant differences of VAS in group comparison,time point comparison and interaction(P<0.05).Further pairwise comparison,VAS of observation group was lower than that of control group at three and five days after operation(P<0.05),VAS at three and five days after operation was lower than that at one day after operation in two groups(P<0.05).The number of time of using analgesia pump in observation group was less than that in control group,and the difference was statistically significant(P<0.05).Total incidence rate of complications in observation group was lower than that in control group(P<0.05).Conclusion The effect of thoracoscopic surgery through xiphoid process approach in lithotomy position for anterior mediastinal tumor is ideal,which can promote the rapid recovery of patients,relieve pain and has high safety.

关 键 词：前纵隔肿瘤 截石位 剑突下 侧卧位 胸腔镜 并发症 

分 类 号：R734.5[医药卫生—肿瘤]