Chen Hao, Xu Bindong, Zhang Qiang, Chen Pengfei, Cai Maoen, Yao Jinmei
Department of Thoracic and Cardiovascular Surgery, The Affiliated Hospital of Putian University, Putian, China.
Turk Gogus Kalp Damar Cerrahisi Derg. 2023 Apr 28;31(2):239-248. doi: 10.5606/tgkdc.dergisi.2023.23455. eCollection 2023 Apr.
This study aims to investigate the effectiveness of application of single-port thoracoscopy using the subxiphoid approach in anterior mediastinal tumor surgery.
Between June 2014 and June 2016, a total of 108 patients (59 males, 49 females; mean age: 64.9±7.5 years; range, 45 to 79 years) with anterior mediastinal tumors were randomized into subxiphoid (experimental) or right chest (control) groups. Single-port thoracoscopy using the subxiphoid approach was performed in the subxiphoid group, while thoracoscopy using the right thoracic approach was performed in the control group. Preand postoperative pain stress indicators, Visual Analog Scale scores, quality of life scores, postoperative tumor recurrence, and five-year survival rates were compared between the groups.
There were no mortality or serious complications in either group. The mean Visual Analog Scale pain scores on postoperative Days 1 and 7 were 6.5±0.8 and 2.9±0.8 in the subxiphoid group, respectively, compared to 7.2±0.8 and 3.4±0.8 in the control group (p<0.05 for all), respectively. The mean quality of life scores on postoperative Days 1 and 7 were 81.5±5.0 and 79.3±7.7, respectively, in the subxiphoid group compared to 72.4±4.3 and 71.3±4.8 in the control group, respectively (p<0.05 for all). Postoperative pain and pain mediator indexes were lower in the subxiphoid group (p<0.05 for all). The postoperative tumor recurrence rates were 3.70% and 20.37% in the subxiphoid and control groups, respectively (p=0.008). The five-year survival rates were 85.2% and 63.0% in the subxiphoid and control groups, respectively (p=0.008).
Single-port thoracoscopy using the subxiphoid approach is technically feasible, safe, and effective in performing surgery for anterior mediastinal tumors with an intact capsule and a tumor diameter of ≤5 cm.
本研究旨在探讨剑突下入路单孔胸腔镜在前纵隔肿瘤手术中的应用效果。
2014年6月至2016年6月，共108例前纵隔肿瘤患者（男59例，女49例；平均年龄：64.9±7.5岁；范围45至79岁）被随机分为剑突下（试验）组或右胸（对照）组。剑突下组采用剑突下入路单孔胸腔镜手术，对照组采用右胸入路胸腔镜手术。比较两组术前和术后疼痛应激指标、视觉模拟评分、生活质量评分、术后肿瘤复发率和五年生存率。
两组均无死亡或严重并发症。剑突下组术后第1天和第7天的视觉模拟评分疼痛平均分分别为6.5±0.8和2.9±0.8，而对照组分别为7.2±0.8和3.4±0.8（均p<0.05）。剑突下组术后第1天和第7天的生活质量评分平均分分别为81.5±5.0和79.3±7.7，而对照组分别为72.4±4.3和71.3±4.8（均p<0.05）。剑突下组术后疼痛和疼痛介质指标较低（均p<0.05）。剑突下组和对照组的术后肿瘤复发率分别为3.70%和20.37%（p=0.008）。剑突下组和对照组的五年生存率分别为85.2%和63.0%（p=0.008）。
剑突下入路单孔胸腔镜技术上可行、安全且有效地应用于完整包膜且肿瘤直径≤5 cm的前纵隔肿瘤手术。
