Li Bin, Niu Lijuan, Gu Chenqi, He Kaiwen, Wu Ruizhi, Pan Zhenfeng, Chen Shaomu
Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Endocrinology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Front Surg. 2022 Sep 9;9:984043. doi: 10.3389/fsurg.2022.984043. eCollection 2022.
To investigate the clinical efficacy of the subxiphoid approach for early anterior mediastinal thymoma and evaluate its advantages over the lateral intercostal approach.
A total of 345 patients with early anterior mediastinal thymoma were retrospectively analyzed from January 2016 to December 2020 in the First Affiliated Hospital of Soochow University. Out of these, 99 patients underwent subxiphoid video-assisted thoracoscopic thymectomy and 246 patients underwent transthoracic video-assisted thoracoscopic thymectomy. We compared the intraoperative conditions (such as operation time and intraoperative blood loss), postoperative conditions [such as postoperative pleural drainage volume, extubation time, postoperative hospital stay, and postoperative visual analogue scale (VAS) pain score], and postoperative complications (such as death, pneumonia, delayed wound healing, cardiac arrhythmia, and phrenic nerve injury) of the two groups and analyzed the clinical advantages of the subxiphoid approach for treating early anterior mediastinal thymoma.
There was no significant difference between the two groups in terms of general clinical features, operation time, and postoperative complications ( > 0.05).However, there was a significant difference in terms of intraoperative blood loss, postoperative pleural drainage volume, tube extubation time, postoperative hospital stay, postoperative VAS pain score, and postoperative analgesics (a significantly decreased flurbiprofen axetil amount) ( < 0.05).
Compared with the lateral intercostal thoracic approach, the subxiphoid approach had advantages in terms of intraoperative blood loss, postoperative hospital stay, tube extubation time, postoperative pleural drainage volume, postoperative VAS pain score, and analgesics dosage. It could provide a better view of the bilateral pleural cavities and more thorough thymectomy and superior cosmesis, and it proved to be a safe and feasible minimally invasive surgical method.
探讨剑突下入路治疗早期前纵隔胸腺瘤的临床疗效，并评估其相对于外侧肋间入路的优势。
回顾性分析2016年1月至2020年12月苏州大学附属第一医院收治的345例早期前纵隔胸腺瘤患者。其中，99例行剑突下电视辅助胸腔镜胸腺切除术，246例行经胸电视辅助胸腔镜胸腺切除术。比较两组患者的术中情况（如手术时间和术中出血量）、术后情况[如术后胸腔引流量、拔管时间、术后住院时间及术后视觉模拟评分法（VAS）疼痛评分]以及术后并发症（如死亡、肺炎、伤口愈合延迟、心律失常及膈神经损伤），并分析剑突下入路治疗早期前纵隔胸腺瘤的临床优势。
两组患者的一般临床特征、手术时间及术后并发症方面差异无统计学意义（>0.05）。然而，术中出血量、术后胸腔引流量、拔管时间、术后住院时间、术后VAS疼痛评分及术后镇痛药（氟比洛芬酯用量显著减少）方面差异有统计学意义（<0.05）。
与外侧肋间胸腔入路相比，剑突下入路在术中出血量、术后住院时间、拔管时间、术后胸腔引流量、术后VAS疼痛评分及镇痛药用量方面具有优势。它能提供更好的双侧胸腔视野，胸腺切除更彻底，美容效果更佳，是一种安全可行的微创手术方法。
