人工气胸联合剑突肋缘下小切口与右侧胸腔入路胸腔镜下胸腺切除手术安全性对照研究  

Comparative study of characteristics and safety of video-assisted thoracoscopic thymectomy between artificial pneumothorax combining subxiphoid-costal margin approach versus right thoracic cavity approach

作　　者：孙耀光[1] 田文鑫[1] 于瀚博 吴青峻[1] 焦鹏[1] 马超[1] 佟宏峰[1] Sun Yaoguang;Tian Wenxin;Yu Hanbo;Wu Qingjun;Jiao Peng;Ma Chao;Tong Hongfeng(Department of Thoracic Surgery,Beijing Hospital,National Center of Gerontology Institue of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院胸外科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730

出　　处：《中华老年医学杂志》2022年第10期1187-1190,共4页Chinese Journal of Geriatrics

摘　　要：目的回顾性分析人工气胸联合剑突肋缘下小切口与经右侧胸腔入路胸腔镜辅助胸腺切除的手术特点和安全性。方法选择2018年1月至2021年12月我科实施的胸腔镜辅助胸腺扩大切除手术251例(包括重症肌无力合并胸腺增生或胸腺瘤,胸腺囊肿以及前纵隔占位病变),进行回顾性分组研究,根据手术方式分为人工气胸联合剑突肋缘下入路(人工气胸组165例)和经右侧胸腔入路(右侧胸腔组86例)。分析两组患者术前基本资料和手术持续时间,术中出血量、术后引流量、引流管留置时间和术后并发症等临床资料。结果两组患者临床资料包括年龄、性别和病理类型(均P>0.05)的差异均无统计学意义。与右侧胸腔组相比,人工气胸组手术持续时间[(108.6±45.2)min和(127.6±42.1)min,t=-3.628,P=0.000],术中出血量[(37.9±131.7)ml和(107.4±284.8)ml,t=-8.215,P=0.000],术后引流量[(379.0±285.5)ml和(646.6±373.34)ml,t=-6.277,P=0.000]和引流管留置时间[(2.2±1.0)d和(3.1±1.0)d,t=-7.275,P=0.000]均明显减少,但在膈神经损伤(1/165例比0/86例,P=1.000),肌无力危象(3/89例比2/66例,χ^(2)=0.014,P=0.906),手术中转开胸(3/165例比2/86例,P=1.000)的发生率等方面,两组的差异均无统计学意义(均P>0.05)。结论人工气胸联合剑突肋缘下小切口胸腔镜辅助胸腺切除手术显露好,安全性高。该术式具有创伤更小,出血少,术后并发症发生率更低的优点,更适用于不能双腔插管、不耐受单肺通气和肺功能不全的老年、女性患者。Objective To proceed a comparative study of characteristics and safety of video-assisted thoracoscopic thymectomy between artificial pneumothorax combining subxiphoid-costal margin approach versus right thoracic cavity approach.Methods From January 2018 to December 2021,251 patients(including myasthenia gravis with thymic hyperplasia or thymoma,thymic cysts and anterior mediastinal occupying lesions)undergoing thoracoscopic extended thymectomy in our department were retrospectively studied,and their clinical data were collected.The surgical methods were divided into artificial pneumothorax combining xiphoid costal margin approach(artificial pneumothorax group,n=165)and via right thoracic approach(right thoracic group,n=86).Clinical data such as preoperative information,operative duration,blood loss,postoperative drainage,drainage duration,and surgical complication were compared between two groups.Results There were no statistical differences in age,gender and pathology between two groups(all P>0.05).Compared with the right thoracic group,operative duration[(108.6±45.2)min vs.(127.6±42.1)min,t=-3.628,P=0.000],intraoperative blood loss[(37.9±131.7)ml vs.(107.4±284.8)ml,t=-8.215,P=0.000],postoperative drainage volume[(379.0±285.5)ml vs.(646.6±373.3 ml),t=-6.277,P=0.000]and drainage duration[(2.2±1.0)d vs.(3.1±1.0)d,t=-7.275,P=0.000]were statistically significantly decreased in the artificial pneumothorax group.No significant difference was found(all P>0.05)in phrenic nerve injury(1/165 vs.0/86,P=1.000),myasthenia crisis(3/89 vs.2/66,χ^(2)=0.014,P=0.906),and the conversion to thoracotomy(3/165 vs.2/86,P=1.000).Conclusions VATS thymectomy by artificial pneumothorax combining subxiphoid-costal margin approach is a safer method,having a less trauma,less bleeding and less incidence rate of complication.Especially,it is more suitable for elderly female patients who cannot be intubated in double lumen,cannot tolerate one-lung ventilation,and have pulmonary insufficiency.

关 键 词：胸腔镜 胸腺切除术 气胸人工 

分 类 号：R655.7[医药卫生—外科学]