经剑突下与经侧胸入路胸腔镜辅助前纵隔肿瘤切除术的疗效对比及对应激反应和炎性因子的影响  

Comparison of the Efficacy of Thoracoscopic Assisted Anterior Mediastinal Tumor Resection Via Subxiphoid and Lateral Thoracic Approach and its Effects on Stress Response and Inflammatory Factors

作　　者：俞经生[1] 高从荣[1] 裴韶华[1] 陈李李[1] 江春苗[1] 孙建 刘让 YU Jing-sheng;GAO Cong-rong;PEI Shao-hua;CHEN Li-li;JIANG Chun-miao;SUN Jian;LIU Rang(Department of Cardiothoracic Surgery,The Second People's Hospital of Hefei(Hefei Hospital Affiliated to Anhui Medical University),Hefei,Anhui,230011,China)

机构地区：[1]合肥市第二人民医院(安徽医科大学附属合肥医院)胸心外科,安徽合肥230011

出　　处：《现代生物医学进展》2024年第17期3332-3336,共5页Progress in Modern Biomedicine

基　　金：安徽省重点研究与开发计划项目(No.201904a07020031)。

摘　　要：目的:对比胸腔镜辅助前纵隔肿瘤切除术患者采用经侧胸入路或经剑突下的应用效果。方法:根据随机数字表法,将115例胸腔镜辅助前纵隔肿瘤切除术患者分为A组(n=57,经侧胸入路)和B组(n=58,经剑突下入路)。对比两组围术期相关指标、应激反应指标、炎症因子,同时观察两组术后并发症发生情况。结果:与A组相比,B组手术时间更长,术中出血量、术后引流量更少,术后住院时间、引流管留置时间更短(P<0.05)。术后1 d,两组神经肽Y(NPY)、5-羟色胺(5-HT)、P物质(SP)、前列腺素E_(2)(PGE_(2))升高,但B组低于A组(P<0.05)。术后1 d,两组C反应蛋白(CRP)、白细胞计数(WBC)、中性粒细胞升高,但B组低于A组(P<0.05)。A组并发症总发生率12.28%,B组的为6.90%,组间对比未见差异(P>0.05)。结论:胸腔镜辅助前纵隔肿瘤切除术手术期间,经剑突下入路虽然较经侧胸入路手术时间更长,但可减轻术中损伤,减轻应激反应和炎症反应,促进患者术后恢复。Objective:To compare the application effects of thoracoscopic assisted anterior mediastinal tumor resection by lateral thoracic approach or subxiphoid approach.Methods:According to the random number table method,115 patients undergoing thoracoscopic assisted anterior mediastinal tumor resection were divided into group A(n=57,lateral thoracic approach)and group B(n=58,subxiphoid approach).The perioperative related indexes,stress response indexes and inflammatory factors were compared between two groups,and the occurrence of postoperative complications was observed.Results:Compared with group A,group B had longer operation time,less intraoperative blood loss and postoperative drainage volume,shorter postoperative hospital stay and drainage tube indwelling time(P<0.05).1 day after operation,neuropeptide Y(NPY),5-hydroxytryptamine(5-HT),substance P(SP)and prostaglandin E_(2)(PGE)_(+))in two groups increased,but group B were lower than those of group A(P<0.05).1 day after operation,C-reactive protein(CRP),white blood cell count(WBC)and neutrophils increased in two groups,but group B were lower than those of group A(P<0.05).The total incidence of complications in group A was 12.28%,and that in group B was 6.90%,there was no difference between two groups(P>0.05).Conclusion:During thoracoscopic assisted anterior mediastinal tumor resection,although the subxiphoid approach takes longer than the lateral thoracic approach,which can reduce intraoperative injury,reduce stress response and inflammatory response,and promote postoperative recovery.

关 键 词：胸腔镜辅助前纵隔肿瘤切除术 经侧胸入路 经剑突下入路 疗效 应激反应 炎性因子 

分 类 号：R734.5[医药卫生—肿瘤]