Xu Hao, Liu Dazhong, Li Yi, Yang Lei, Wang Fei, Wang Wei, Zhang Linyou
Department of Thoracic Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, China.
J Laparoendosc Adv Surg Tech A. 2020 May;30(5):508-513. doi: 10.1089/lap.2019.0734. Epub 2020 Jan 31.
The subxiphoid thoracoscopic approach may be an alternative to the lateral transthoracic approach in the treatment of thymic diseases. This study aimed to assess the safety and efficacy of subxiphoid video-assisted thoracoscopic surgery and compare this approach with the lateral transthoracic variation in terms of short-term perioperative outcomes. Data for 107 consecutive adult patients who underwent transthoracic or subxiphoid video-assisted thoracic surgery for thymic diseases from July 2015 to February 2019 were retrospectively reviewed. The patients were stratified according to whether they had accompanying myasthenia gravis (MG). Perioperative outcomes were compared between the two cohorts. A total of 107 patients were identified, including 37 patients who underwent subxiphoid video-assisted thoracoscopic thymectomy (S-VATT) and 70 patients who underwent transthoracic video-assisted thoracoscopic thymectomy (T-VATT). The S-VATT group exhibited less operative blood loss (112.14 ± 117.01 versus 58.81 ± 48.67, = .003), a shorter duration of chest tube usage (3.77 ± 1.83 versus 2.18 ± 1.88, = .000), lower postoperative pain scores (4.99 ± 0.99 versus 1.57 ± 0.55, = .000), and a shorter length of postoperative hospital stay (5.83 ± 1.38 versus 4.38 ± 1.26, = .000) than the T-VATT group. For MG patients, the median operative time was significantly shorter in the S-VATT group than in the T-VATT group (141.46 ± 54.17 versus 95.63 ± 31.25, = .004). S-VATT is a safe approach for patients with thymic diseases and has potential advantages of a shorter operative time, less intraoperative bleeding, and less postoperative pain compared with the lateral transthoracic approach, especially for patients with MG.
剑突下胸腔镜入路可能是治疗胸腺疾病时外侧经胸入路的一种替代方法。本研究旨在评估剑突下电视辅助胸腔镜手术的安全性和有效性，并在围手术期短期结局方面将该入路与外侧经胸入路进行比较。回顾性分析了2015年7月至2019年2月期间连续107例因胸腺疾病接受经胸或剑突下电视辅助胸腔手术的成年患者的数据。根据患者是否伴有重症肌无力（MG）进行分层。比较了两组患者的围手术期结局。共确定了107例患者，其中37例接受了剑突下电视辅助胸腔镜胸腺切除术（S-VATT），70例接受了经胸电视辅助胸腔镜胸腺切除术（T-VATT）。S-VATT组的术中失血量更少（112.14±117.01对58.81±48.67，P = 0.003），胸腔引流管使用时间更短（3.77±1.83对2.18±1.88，P = 0.000），术后疼痛评分更低（4.99±0.99对1.57±0.55，P = 0.000），术后住院时间更短（5.83±1.38对4.38±1.26，P = 0.000）。对于MG患者，S-VATT组的中位手术时间显著短于T-VATT组（141.46±54.17对95.63±31.25，P = 0.004）。剑突下电视辅助胸腔镜胸腺切除术对于胸腺疾病患者是一种安全的手术方法，与外侧经胸入路相比，具有手术时间短、术中出血少和术后疼痛轻等潜在优势，尤其对于MG患者。
