经剑突下入路与经肋间入路胸腔镜术治疗前纵隔肿瘤的效果差异

doi:10.3969/j.issn.1006-6233.2024.02.028

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Abstract Objective: To investigate the surgical outcomes and complications of subxiphoid thoracoscopic surgery and intercostal thoracoscopic surgery for anterior mediastinal tumors. Methods: A total of 100 patients with anterior mediastinal tumors who underwent thoracoscopic surgery at Xuancheng People's Hospital from January 2020 to January 2023 were enrolled in this study. According to the surgical approach, the patients were divided into the subxiphoid group (subxiphoid thoracoscopic surgery, 60 cases) and the intercostal group (intercostal thoracoscopic surgery, 40 cases). The perioperative indicators (intraoperative blood loss, postoperative drainage volume, operation time, number of pain pump uses), rehabilitation indicators (drainage tube retention time, postoperative analgesic drug use time, hospital stay), different time points of pain visual analog scale (VAS) scores, and postoperative 7, 15, 30, and 45 days Karnofsky performance status (KPS) scores, and complication rates (pleural effusion, pneumothorax, atelectasis, pulmonary infection) were compared between the two groups. Results: The intraoperative blood loss in the sternotomy group was (24.67±3.21) mL, which was lower than that in the intercostal group [(40.13±4.29)mL, P<0.05]; the postoperative drainage volume was (151.95±17.12) mL, which was lower than that in the intercostal group [(306.50±30.52)mL, P<0.05]; the operation time was (66.00±6.59) min, which was shorter than that in the intercostal group [(91.65±10.51)min, P<0.05]; the number of pain pump uses was (6.07±1.02) times, which was lower than that in the intercostal group [(7.10±1.22)times, P<0.05]. The drainage tube retention time in the sternotomy group was (17.20±3.19) h, which was lower than that in the intercostal group [(21.77±3.97)h, P<0.05]; the postoperative analgesic drug use time was (1.85±0.92) d, which was shorter than that in the intercostal group [(3.10±0.90)d, P<0.05]; the hospital stay was (6.10±1.32) d, which was shorter than that in the intercostal group [(8.75±1.66)d, P<0.05]. The VAS scores of patients in the sternotomy group were (2.02±0.43) points before surgery, which were not significantly different from those in the intercostal group [(2.00±0.45)points, P>0.05]; the VAS scores were (4.57±1.44) points at 1 day after surgery, which were significantly lower than those in the intercostal group [(5.83±1.48)points, P<0.05]; the VAS scores were (3.00±1.01) points at 2 days after surgery, which were significantly lower than those in the intercostal group [(4.38±1.39)points, P<0.05]; the VAS scores were (2.40±0.62) points at 3 days after surgery, which were significantly lower than those in the intercostal group [(3.42±0.81)points, P<0.05]. The KPS score of subxiphophorus group was (60.13±3.20) points at 7 days after operation, which was significantly higher than that of intercostal group [(57.38±4.20) points, P<0.05]. 15 days after surgery, the score was (65.78±3.09), significantly higher than that in intercostal group [(62.17±3.76), P<0.05]. The score at 30d after operation was (71.50±3.71) points, significantly higher than that in intercostal group [(68.10±3.86) points, P<0.05]. The score at 45 days after operation was (81.67±5.07), significantly higher than that in intercostal group [(75.45±5.20), P<0.05]. The total incidence of complications was lower than that of intercostal group, the difference was statistically significant (P<0.05). Conclusion: Thoracoscopy via subxiphoid approach is ideal for the treatment of anterior mediastinal tumors, which can effectively improve patients' pain and functional status and reduce the occurrence of complications.

Key words： Anterior mediastinal tumors Thoracoscopic surgery Different approaches Efficacy Complication Effect

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2024.02.028 OR http://www.hbyxzzs.cn/EN/Y2024/V30/I2/316

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