经剑突下与侧胸壁入路在前纵膈手术的临床应用研究  

Clinical application of subxiphoi and lateral chest wall approach in anterior mediastinal surgery

作　　者：何俊明[1] 付印 楼国梁[1] 陈健 胡江苇 管伟[1] HE Junming;FU Yin;LOU Guoliang(Yiwu Central Hospital,Zhejiang 322000,China)

机构地区：[1]浙江省义乌市中心医院,义乌322000

出　　处：《浙江创伤外科》2022年第1期9-12,共4页Zhejiang Journal of Traumatic Surgery

摘　　要：目的研究经剑突下胸腔镜技术应用于前纵膈肿物外科治疗的临床效果。方法选取2018年6月至2021年5月间本院收治的93例前纵膈肿物患者,随机分为对照组(n=46)和试验组(n=47),对照组采用经单侧胸(左/右)胸腔镜下前纵膈肿物切除术治疗,试验组采用经剑突下胸腔镜技术前纵膈肿物切除术治疗,比较两组的临床治疗效果。结果从术中指标来看,试验组患者的手术视野暴露评分高于对照组、术中出血量少于对照组,差异均有统计学意义(P<0.05);两组患者的手术时间、中转开胸率均无显著差异(P>0.05)。从术后指标来看,试验组患者的术后胸腔引流量少于对照组,胸管留置时间、止痛药使用时间、术后住院时间均短于对照组,术后试验组患者的VAS切口疼痛评分均低于对照组,术后试验组患者血浆中皮质醇、促肾上腺皮质激素浓度均低于对照组,试验组患者的术后并发症发生率低于对照组,差异均有统计学意义(P<0.05);两组住院医疗费用无显著差异(P>0.05)。结论经剑突下胸腔镜技术应用于前纵膈肿物的外科治疗,有利于充分暴露前纵膈手术视野,减少术中出血量和术后引流量,减轻疼痛程度和手术应激程度,并且加快术后康复,在医疗设备和技术成熟的情况下,值得大力推广应用。Objective To study the clinical effect of transxiphoid thoracoscopy in the surgical treatment of anterior mediastinal masses.Methods 93 patients with anterior mediastinal masses treated in our department from June 2018 to may 2021 were randomly divided into control group(n=46)and experimental group(n=47).The control group was treated by unilateral thoracic(left/right)thoracoscopy,and the experimental group was treated by transxiphoid thoracoscopy.The clinical therapeutic effects were compared.Results In terms of intraoperative indexes,the vision exposed score in the experimental group was higher than control group,and the intraoperative bleeding was less than control group(P<0.05).There was no significant difference in operation time and conversion rate to thoracotomy between the two groups(P>0.05).In terms of postoperative indexes,the postoperative thoracic drainage volume of patients in the experimental group was less than that in the control group.The chest tube retention time,analgesic use time,hospital stay time in the experimental group were shorter than those in the control group.The VAS incision pain score postoperative in the experimental group was lower than that in the control group,and the plasma cortisol and adrenocorticotropic hormone concentrations of patients in the experimental group were lower than those in the control group.The incidence of postoperative complications in the experimental group was lower than that in the control group(P<0.05).There was no significant difference in hospitalization medical expenses between the two groups(P>0.05).Conclusion the application of transxiphoid thoracoscopy in the surgical treatment of anterior mediastinal mass is conducive to fully expose the visual field of anterior mediastinal surgery,reduce the amount of intraoperative bleeding and postoperative drainage,reduce the degree of pain and surgical stress,and accelerate the postoperative rehabilitation.When the medical equipment and technology are mature,it is worthy to greatly promotion and application.

关 键 词：经剑突下 经单侧胸 胸腔镜技术 前纵膈肿物 

分 类 号：R734.2[医药卫生—肿瘤]