Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, China.
Department of Surgery, The University of Hong Kong Shenzhen Hospital, Hong Kong, China.
Eur J Cardiothorac Surg. 2018 Jan 1;53(1):216-220. doi: 10.1093/ejcts/ezx217.
Although there is growing interest in single-port video-assisted thoracic surgery for a number of thoracic operations, there is still not enough known about its use for mediastinal pathologies. The present study was aimed at assessing the safety and efficacy of single-port video-assisted thoracic surgery in comparison with the multi-port variants in terms of short-term perioperative outcomes.
From July 2013 to December 2015, 285 consecutive non-myasthenic adult patients undergoing single- or multi-port video-assisted thoracic surgery for mediastinal diseases including thymoma were retrospectively reviewed. Patients were stratified depending on whether the pathology was thymoma. A propensity score matching pertaining to the approach used was performed within each stratified category. Perioperative outcomes were compared between matched cohorts.
During the study period, 141 (49.5%) patients were treated with single-port thoracoscopic surgery. Preoperative variables were comparable between both pairs of cohorts after matching. No morbidity or mortality occurred, except 1 case of empyema in a 2-port case. Single-port technique exhibited shorter operation time (thymoma: 78.8 vs 120.0 min, P = 0.011; non-thymoma: 78.4 vs 107.9 min, P < 0.001), less intraoperative blood loss (thymoma: 42.0 vs 78.4 ml, P = 0.002; non-thymoma: 46.0 vs 62.2 ml, P = 0.001) and a lower postoperative 10-point visual analogue scale pain score (thymoma: 2.6 vs 3.3, P = 0.026; non-thymoma: 2.4 vs 3.2, P < 0.001) than multi-port techniques in both patient categories.
Single-port video-assisted thoracic surgery is a safe approach for patients with loco-regional mediastinal disease, with potential advantages of shorter operative time, less intraoperative bleeding and less postoperative pain when compared with multi-port techniques.
虽然单孔电视辅助胸腔镜手术在许多胸腔手术中越来越受到关注，但对于纵隔病变的应用仍知之甚少。本研究旨在评估单孔电视辅助胸腔镜手术与多孔电视辅助胸腔镜手术在短期围手术期结果方面的安全性和有效性。
回顾性分析 2013 年 7 月至 2015 年 12 月期间 285 例非重症成年患者，因纵隔疾病（包括胸腺瘤）接受单孔或多孔电视辅助胸腔镜手术。根据病理是否为胸腺瘤，将患者分层。在每个分层类别内，针对所使用的方法进行倾向评分匹配。比较匹配队列之间的围手术期结果。
在研究期间，141 例（49.5%）患者接受了单孔胸腔镜手术治疗。匹配后，两组患者的术前变量无差异。除 1 例 2 孔病例发生脓胸外，无并发症或死亡发生。单孔技术的手术时间更短（胸腺瘤：78.8 分钟比 120.0 分钟，P=0.011；非胸腺瘤：78.4 分钟比 107.9 分钟，P<0.001），术中出血量更少（胸腺瘤：42.0 毫升比 78.4 毫升，P=0.002；非胸腺瘤：46.0 毫升比 62.2 毫升，P=0.001），术后 10 分视觉模拟疼痛评分更低（胸腺瘤：2.6 分比 3.3 分，P=0.026；非胸腺瘤：2.4 分比 3.2 分，P<0.001）。
单孔电视辅助胸腔镜手术是治疗局部纵隔疾病患者的一种安全方法，与多孔技术相比，具有手术时间更短、术中出血更少和术后疼痛更轻的潜在优势。
