Mao Yong, Lan Yuting, Cui Fei, Deng Hongsheng, Zhang Yaoliang, Wu Xi, Liang Wenhua, Liu Jun, Liang Hengrui, He Jianxing
Department of Cardiothoracic Surgery, Ningbo First Hospital, Ningbo, China.
Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.
J Thorac Dis. 2020 Oct;12(10):5430-5439. doi: 10.21037/jtd-20-266.
Different video-assisted thoracoscopic surgery (VATS) approaches may related to heterogeneous clinical outcomes in anterior mediastinal tumor surgery. Herein, we assessed the comparison between the subxiphoid and intercostal approach, and also compare the left versus the right incision in the intercostal approach for anterior mediastinal tumor patients.
Clinical data of patients receiving thoracoscopic anterior mediastinal tumor resection were retrospectively collected. Patients were divided into two groups according to the approaches: subxiphoid and the intercostal group. The intercostal group was further subdivided into two groups according to different sides: left and right incision group. Intraoperative and postoperative variables were compared between subgroups.
A total of 238 patients were consecutively included in this analysis; 198 (83.2%) patients received intercostal procedure and 40 (16.8%) patients received subxiphoid approach. After 1:1 propensity score matching, all baseline characters were well balanced between intercostal and subxiphoid approach, left and right intercostal approach. The visual analogue scale (VAS) pain score was lower in patients underwent subxiphoid approach than intercostal group at first post-operative evaluation in 12-24 h (4.36 . 2.23; P=0.03). According to left and right approach, postoperative drainage time (1.9 . 1.2 days, P=0.016), postoperative drainage volume (312.1 . 193.9 mL, P=0.041) and hospitalization time (5.3 . 4.1 days, P=0.043) were significantly increased in the left thoracic approach group compared with the right thoracic approach.
Subxiphoid approach is associated with less pain compared with intercostal approach. The right intercostal thoracic approach may offer better clinical effect of short-term postoperative recovery.
不同的电视辅助胸腔镜手术（VATS）入路可能与前纵隔肿瘤手术的临床结局异质性相关。在此，我们评估了剑突下入路与肋间入路之间的比较，并比较了肋间入路中左侧与右侧切口用于前纵隔肿瘤患者的情况。
回顾性收集接受胸腔镜下前纵隔肿瘤切除术患者的临床资料。根据入路将患者分为两组：剑突下入路组和肋间入路组。肋间入路组根据不同的侧别进一步细分为两组：左侧和右侧切口组。比较各亚组之间的术中及术后变量。
本分析共连续纳入238例患者；198例（83.2%）患者接受肋间手术，40例（16.8%）患者接受剑突下入路。经过1:1倾向评分匹配后，肋间入路与剑突下入路、左侧与右侧肋间入路之间所有基线特征均良好平衡。在术后12 - 24小时首次评估时，接受剑突下入路的患者视觉模拟量表（VAS）疼痛评分低于肋间入路组（4.36 ± 2.23；P = 0.03）。根据左侧和右侧入路，与右侧胸腔入路相比，左侧胸腔入路组术后引流时间（1.9 ± 1.2天，P = 0.016）、术后引流量（第312.1 ± 193.9 mL，P = 0.041）和住院时间（5.3 ± 4.1天，P = 0.043）显著增加。
与肋间入路相比，剑突下入路疼痛较轻。右侧肋间胸腔入路可能在术后短期恢复方面具有更好的临床效果。
