经剑突下三孔胸腔镜手术对前纵隔肿瘤患者围术期指标、应激反应及并发症的影响  

Effect of Subxiphoid Three-port Video-assisted Thoracoscopic Surgery on Perioperative Indicators and Stress Response and Complications in Patients with Anterior Mediastinal Tumors

作　　者：陈颖 李伟[1] 刘长增 段东奎[1] CHEN Ying;LI Wei;LIU Changzeng(Nanyang Central Hospital(Nanyang Cancer Hospital),Nanyang,473000)

机构地区：[1]河南省南阳市中心医院,南阳市肿瘤医院,473000 [2]南阳医专第二附属医院,473000

出　　处：《实用癌症杂志》2024年第8期1276-1279,共4页The Practical Journal of Cancer

基　　金：2020年度河南省医学科技攻关计划联合共建立项项目(编号:LHGJ20200907)。

摘　　要：目的研究经剑突下三孔胸腔镜手术对前纵隔肿瘤患者围术期指标、应激反应及并发症的影响。方法选取行胸腔镜下前纵隔肿瘤切除术的患者68例,根据入路不同分为A、B 2组,各34例,A组为经侧胸入路,B组为经剑突下三孔入路。对比2组围术期指标、应激反应和术后并发症发生情况。结果在围术期指标方面,2组手术时长、手术失血量、引流天数、术后住院时长无统计学差异,而术后首次下地时间和术后止痛药使用时长则为经剑突下三孔入路组显著短于经侧胸入路组(P<0.05),且经剑突下三孔入路组术后d2、d3的VAS评分更低(P<0.05),差异有统计学意义。在疼痛相关应激反应指标方面,2组患者术后Cor、PGE2、SP血清学指标均高于正常值,但经侧胸入路组较经剑突下三孔入路组更高(P<0.05),差异有统计学意义。在并发症方面,2组患者在肺部感染、肺漏气、心律失常、肺不张、胸腔积液及皮肤感觉异常情况方面无统计学差异,而总体并发症发生率则为经剑突下三孔入路组显著低于经侧胸入路组(P<0.05)。结论经剑突下三孔胸腔镜手术治疗前纵隔肿瘤能明显减轻患者围术期的疼痛,降低术后应激反应强度,并且能有效减少肺不张、胸腔积液及皮肤感觉异常方面的并发症发生率。Objective To explore the effect of subxiphoid three-port video-assisted thoracoscopic surgery on perioperative indicators and stress complications in patients with anterior mediastinal tumors.Methods 68 patients who underwent video-assisted thoracoscopic resection of anterior mediastinal tumors were selected,and divided into 2 groups according to the different surgical approaches,each with 34 cases.Group A was performed via lateral thoracic approach,while group B was via subxiphoid three-port approach.Then the evaluation criteria including perioperative indicators,stress response,and postoperative complications were compared between groups.Results In terms of perioperative indicators,the operation duration,intraoperative blood loss,days with drainage and postoperative length of stay yielded no statistical difference between the 2 groups(P>0.05),while group B had decreased time to first out-of-bed activity and shorter time of postoperative analgesic use than those of group A(P<0.05).Group B scored lower on VAS than group A at postoperative d2 and d3(P<0.05).The pain substances and stress response substances cortisol(Cor),prostaglandin E2(PGE2)and substance P(SP)were all above normal values,and the 3 indicators were all higher in group B than in group A(P<0.05).No statistical difference was found in the incidence rate of lung infections,pulmonary leakage,arrhythmia,atelectasis,pleural effusion,and abnormal skin sensation between the 2 groups(P>0.05),while the overall complication rate of group B was lower than that of group A(P<0.05).Conclusion The treatment of anterior mediastinal tumors through subxiphoid three-port video-assisted thoracoscopic surgery can significantly alleviate perioperative pain,attenuate postoperative stress response,and effectively reduce the incidence of complications such as atelectasis,pleural effusion,and skin sensory abnormalities.

关 键 词：胸腔镜 前纵隔肿瘤 经剑突下入路 围术期指标 应激反应 并发症 

分 类 号：R734.5[医药卫生—肿瘤]