胸腔镜下经剑突肋缘下入路与经肋间入路纵隔肿物切除术近期疗效的比较  

Comparison of Short-Term Efficacy of Mediastinal Tumor Resection via Subcostal Incision and Intercostal Approach under Thoracoscope

作　　者：梁冠标[1] 阳诺[1] 李昌钤 李泳朋 LIANG Guanbiao;YANG Nuo;LI Changqian(The First Affiliated Hospital of Guangxi Medical University,Guangxi Nanning 530022,China)

机构地区：[1]广西医科大学第一附属医院心胸外科,广西南宁530022

出　　处：《河北医学》2024年第4期603-608,共6页Hebei Medicine

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(编号:Z-A20230525)。

摘　　要：目的:对比分析胸腔镜下经剑突肋缘下入路与经肋间入路纵隔肿物切除术近期疗效。方法:选取广西医科大学第一附属医院心胸外科2019年1月至2022年1月接受胸腔镜下经剑突肋缘下或经肋间入路行纵隔肿物切除术患者157例,按照手术入路不同分为经剑突组(n=56)或经肋间组(n=102),经倾向性评分匹配后,剑突组与肋间组各纳入52例患者。比较两组手术相关指标(术后胸腔引流量、术中出血量、引流管留置时间、手术时间、卧床时间、自主按压镇痛泵次数及住院费用)、术后并发症发生率、疼痛程度,术前、术后1d、3d及5d采用电化学发光法、酶联免疫吸附法分别测定血清肌红蛋白(Mb)、神经生长因子(NGF)、肌酸磷酸激酶(CPK)、前列腺素E2(PGE2)水平。结果:经剑突组术后引流管留置时间(2.37±1.05)d、卧床时间(1.37±0.65)d、住院时间(6.07±1.82)d、术中出血量(72.26±9.41)mL、胸腔引流量(248.74±80.41)mL、自主按压镇痛泵次数(3.72±0.98)次、住院费用(3.10±0.84)万元均较经肋间组(3.02±1.31)d、(1.92±0.70)d、(7.31±2.13)d、(85.33±12.69)mL、(325.96±95.22)mL、(8.41±2.17)次,(3.76±1.22)万元少(t=2.792、4.152、3.192、5.966、4.468、14.204、3.213,P均<0.05);术后1d、3d及5d,经剑突组Mb、CPK、NGF、PGE2均较经肋间组低(P<0.05);术后1d、7d及1个月、3个月,经剑突组疼痛VAS评分均较经肋间组低(P<0.05);经剑突组术后并发症发生率1.92%(1/52)较经肋间组17.31%(9/52)低(χ^(2)=7.081,P<0.05)。结论:相较于胸腔镜下经肋间入路,经剑突肋缘下入路纵隔肿物切除术可明显减轻患者肌肉损伤及疼痛程度,手术安全、可靠,有助于患者术后恢复,且住院费用相对较少。Objective:To compare the short-term efficacy of video-assisted thoracoscopic(VATS)trans-xiphoid subcostal and intercostal approaches for mediastinal tumor resection.Methods:A total of 157 patients who underwent thoracoscopic mediastinal tumor resection via the xiphoid process or intercostal ap-proach in the Department of Cardiothoracic Surgery,the First Affiliated Hospital of Guangxi Medical University from January 2019 to January 2022 were selected.They were divided into the xiphoid process group(n=56)or intercostal group(n=102)according to the surgical approach.After propensity score matching,52 patients were included in each group.The two groups were compared for surgery-related indicators[postoperative chest drainage volume,intraoperative blood loss,drainage tube indwelling time,operation time,bed rest time,number of self-pressing analgesia pumps,and hospitalization costs],postoperative complication rate,and pain level.Serum myoglobin(Mb),nerve growth factor(NGF),creatine phosphokinase(CPK),and prostaglandin E2(PGE2)levels were measured using electrochemiluminescence and enzyme-linked immu-nosorbent assay before surgery,and on days 1,3,and 5 after surgery.Results:The indwelling time of drain-age tube(2.37±1.05)days,bed rest time(1.37±0.65)days,hospitalization time(6.07±1.82)days,in-traoperative blood loss(72.26±9.41)ml,chest drainage volume(248.74±80.41)ml,the number of times of self-pressing the analgesia pump(3.72±0.98)times,and hospitalization costs(3.10±0.84)million yuan in the xiphoid group were less than those in the intercostal group(3.02±1.31)days,(1.92±0.70)days,(7.31±2.13)days,(85.33±12.69)ml,(325.96±95.22)ml,(8.41±2.17)times,and(3.76±1.22)million yuan(t=2.792,4.152,3.192,5.966,4.468,14.204,3.213,P<0.05);at 1 d,3 d and 5 d af-ter surgery,Mb,CPK,NGF and PGE2 in the xiphoid group were lower than those in the intercostal group(P<0.05);at 1 d,7 d and 1 month,3 months after surgery,the pain VAS scores in the xiphoid group were lower than those in the intercostal group(P<0.05);the incidence

关 键 词：纵隔肿物 胸腔镜手术 剑突肋缘入路 肋间入路 倾向性匹配 

分 类 号：R655.5[医药卫生—外科学]