胸骨拉钩配合人工气胸在胸腔镜前纵隔肿瘤切除手术膈神经保护中的作用  

Effect of sternal retractor combined with artificial pneumothorax on phrenic nerve protection in thoracoscopic mediastinal tumor surgery

作　　者：季中华 郑中锋 游锦智 王瑞 JI Zhong-Hua;ZHENG Zhong-Feng;YOU Jin-Zhi(Department of Thoracic Surgery,Suqian Hospital,Nanjing Gulou Hospital Group,Suqian 223800,Jiangsu,China)

机构地区：[1]南京鼓楼医院集团宿迁医院胸外科,江苏宿迁223800 [2]南京鼓楼医院集团宿迁医院肿瘤科,江苏宿迁223800

出　　处：《吉林医学》2024年第8期1821-1824,共4页Jilin Medical Journal

基　　金：江苏省科协青年科技人才托举工程项目[项目编号:JSTJ-2022-004]。

摘　　要：目的:探讨胸骨拉钩配合人工气胸在胸腔镜前纵隔肿瘤切除手术中膈神经保护作用、术中指标和术后康复水平。方法:回顾性分析南京鼓楼医院集团宿迁医院收治的55例胸腔镜前纵隔肿瘤患者的临床资料。采取胸骨拉钩配合人工气胸经剑突入路接受膈神经保护的22例为研究组,采取胸腔镜传统侧进胸未接受膈神经保护的33例为对照组,比较两组各项指标和术后膈神经损伤情况。结果:55例患者均完成手术,研究组手术中膈神经损伤率低于对照组,差异有统计学意义(P<0.05)。研究组在术后手术时间、出血量、疼痛评分、通气时间方面均优于对照组,差异有统计学意义(P<0.05),两组在住院时间、引流管留置时间等方面比较,差异无统计学意义(P>0.05)。结论:对于前纵隔肿瘤患者,采取胸骨拉钩配合人工气胸经剑突入路实行膈神经的保护效果较传统术式有显著的提升,具有降低术中创伤、促进术后康复、减少术后并发症的优势。Objective To investigate the protective effect of sternal retractor combined with artificial pneumothorax on phrenic nerve,intraoperative indexes and postoperative rehabilitation in thoracoscopic anterior mediastinal tumor resection.Method The clinical data of 55 patients with thoracoscopic anterior mediastinal tumor admitted to Suqian Hospital of Nanjing Gulou Hospital Group were retrospectively analyzed.The study group consisted of 22 patients who received phrenic nerve protection with sternal retracting hook combined with artificial pneumothorax via sword burst approach,and the control group consisted of 33 patients who did not receive phrenic nerve protection through thoracoscopic traditional lateral thoracoscopy.Compare various indicators and postoperative phrenic nerve injury.Results All the 55 patients completed the operation.The rate of phrenic nerve injury in the study group was lower than that in the control group,and the difference was statistically significant(P<0.05).Patients in the study group were higher than those in the control group in terms of postoperative operation time,blood loss,pain score and ventilation time,with statistical significance(P<0.05),while there was no statistical significance in terms of hospitalization time and drainage tube retention time between the two groups(P>0.05).Conclusion For patients with anterior mediastinal tumor,the protective effect of phrenic nerve with sternal retractor combined with artificial pneumothorax through sword approach is significantly improved compared with traditional operation,and has the advantages of reducing intraoperative trauma,promoting postoperative rehabilitation and reducing postoperative complications,which is worthy of clinical application.

关 键 词：纵隔 肿瘤 拉钩 人工气胸 电视胸腔镜 膈神经 

分 类 号：R734.5[医药卫生—肿瘤]