Leng Xuechun, Chen Mengzou, Zhang Yang, Gao Jian, You Zhenbing, Hu Zhongwu
Department of Thoracic Surgery, The Affiliated Huaian No.1 People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China.
Department of Anesthesiology, The Affiliated Huaian No.1 People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China.
Front Surg. 2024 Dec 3;11:1463881. doi: 10.3389/fsurg.2024.1463881. eCollection 2024.
While the subxiphoid approach (SA) in thoracoscopic thymectomy offers benefits in terms of fat removal and pain reduction, it remains unclear which patients with anterior mediastinal masses benefit most from the subxiphoid vs. the lateral intercostal approach (LA).
This retrospective study analyzed patients treated for anterior mediastinal masses at our center from January 2019 to December 2023. Patients were categorized into two groups based on the surgical approach: SA (35 cases) and LA (56 cases). Demographic data, clinical characteristics, perioperative metrics, and short-term outcomes were compared.
Ninety-one patients were included, with diagnoses including thymic cysts (43), thymomas types A, AB, and B1 (24), B2 thymomas (18), thymic carcinoma (6).No significant differences were found between the groups in terms of gender, age, tumor size, body mass index, conversion to sternotomy, or blood loss. The LA group, however, experienced shorter surgical durations ( < 0.001), less drainage ( = 0.021), shorter hospital stays ( < 0.001), and lower hospitalization costs ( = 0.024). Pain scores on the visual analogue scale were similar between groups on the day of surgery and the first postoperative day.
The findings suggest that the lateral intercostal approach is preferable for patients with thymic cysts and Masaoka stage I-II thymomas without myasthenia gravis due to its efficiency and cost-effectiveness.
虽然胸腔镜胸腺切除术的剑突下入路（SA）在脂肪清除和疼痛减轻方面具有优势，但对于前纵隔肿块患者，剑突下入路与外侧肋间入路（LA）相比，哪类患者获益最大仍不明确。
这项回顾性研究分析了2019年1月至2023年12月在本中心接受前纵隔肿块治疗的患者。根据手术入路将患者分为两组：剑突下入路（35例）和外侧肋间入路（56例）。比较了人口统计学数据、临床特征、围手术期指标和短期结局。
纳入91例患者，诊断包括胸腺囊肿（43例）、A、AB和B1型胸腺瘤（24例）、B2型胸腺瘤（18例）、胸腺癌（6例）。两组在性别、年龄、肿瘤大小、体重指数、转为胸骨切开术或失血量方面无显著差异。然而，外侧肋间入路组手术时间较短（<0.001）、引流量较少（=0.021）、住院时间较短（<0.001）、住院费用较低（=0.024）。手术当天和术后第一天，两组视觉模拟量表疼痛评分相似。
研究结果表明，对于胸腺囊肿和无重症肌无力的Masaoka I-II期胸腺瘤患者，外侧肋间入路因其效率和成本效益而更可取。
