经剑突下与经侧胸入路胸腔镜手术在胸腺瘤切除中的应用比较
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摘要
目的对比经剑突下和经侧胸入路胸腔镜手术在胸腺瘤切除中的临床应用效果。方法收集接受胸腺瘤切除手术的患者46例,经纳入排除标准筛选后一共32例患者纳入本研究,所有患者都为Ⅰ期胸腺瘤患者,有15例伴随重症肌无力(MG)。其中16例接受经剑突下入路胸腔镜胸腺瘤切除术(A组),另外16例接受经侧胸入路胸腔镜胸腺瘤切除术(B组)。收集两组患者的基本临床信息,围手术期以及术后并发症情况。结果经剑突下入路胸腔镜胸腺瘤切除术和经侧胸入路胸腔镜胸腺瘤切除术的手术时间分别为(91.88±12.37)min和(151.25±32.84)min,差异有统计学意义(P<0.001);术中出血量分别为(48.75±16.68)mL和(57.81±13.29) mL,差异有统计学意义(P=0.100);术后引流量分别为(176.88±56.65)mL和(233.75±46.17)mL,差异有统计学意义(P=0.004);术后住院时间分别为(4.87±1.59)d和(5.38±1.26)d,差异无统计学意义(P=0.331);胸腔引流管留置时间分别为(2.37±0.95)d和(3.00±1.15)d,差异无统计学意义(P=0.106);切口疼痛评分分别为(2.38±1.15)分和(5.63±1.99)分,差异有统计学意义(P<0.001)。两组患者术后并发症发生率差异无统计学意义(P>0.05),MG状态在经剑突下入路胸腔镜胸腺瘤切除术后消失的患者比例相对经侧胸入路胸腔镜胸腺瘤切除术具有统计学差异的趋势,但差异无统计学意义(P=0.119)。结论相对经侧胸入路胸腔镜胸腺瘤切除术,经剑突下入路胸腔镜切除术具有更好的临床获益,显示出巨大的应用价值。
引文
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[14] Yuan ZY, Cheng GY, Sun KL, et al. Comparative study of video-assisted thoracic surgery versus open thymectomy for thymoma in one single center[J]. J Thorac Dis, 2014, 6(6):726-733.
[15] Odaka M, Shibasaki T, Asano H, et al. Feasibility of thoracoscopic thymectomy for treatment of early-stage thymoma[J]. Asian J Endosc Surg, 2016, 8(4):439-444.
[2] Duwe BV, Sterman DH, Musani AI. Tumors of the mediastinum[J]. Chest, 2005,128(4):2893-2909.
[3] Davenport E, Malthaner RA. The role of surgery in the management of thymoma: a systematic review[J]. Ann Thorac Surg, 2008, 86(2):673-684.
[4] Raza A, Woo E. Video-assisted thoracoscopic surgery versus sternotomy in thymectomy for thymoma and myasthenia gravis[J]. Ann Cardiothorac Surg, 2016, 5(1):33-37.
[5] Pennathur A, Qureshi I, Schuchert MJ, et al. Comparison of surgical techniques for early-stage thymoma: feasibility of minimally invasive thymectomy and comparison with open resection[J]. J Thorac Cardiovascul Surg, 2011, 141(3):694-701.
[6] Jurado J, Javidfar J, Newmark A, et al. Minimally invasive thymectomy and open thymectomy: outcome analysis of 263 patients[J]. Ann Thorac Surg, 2012, 94(3):974-982.
[7] Evoli A. Myasthenia gravis: new developments in research and treatment[J].Curr Opin Neurol, 2017, 30(5):464-470.
[8] Hsu CP. Subxiphoid approach for thoracoscopic thymectomy[J]. Surg Endosc, 2002, 16(7):1105.
[9] 张科, 童继春, 吴奇勇.经剑突下胸腔镜技术在胸腺瘤切除术中的应用[J]. 中国微创外科杂志, 2018, 18(2):107-109.
[10] Suda T, Kaneda S, Hachimaru A, et al. Thymectomy via a subxiphoid approach: single-port and robot-assisted[J]. J Thorac Dis, 2016, 8(Suppl 3):S265-S271.
[11] Suda T, Sugimura H, Tochii D, et al. Single-port thymectomy through an infrasternal approach[J]. Ann Thorac Surg, 2012, 93(1):334-336.
[12] Blalock A, Harvey AM, Ford FR, et al. The treatment of myasthenia gravis by removal of the thymus gland[J]. J Am Med Assoc, 1941, 117(18):1529-1533.
[13] 汪灏,谷志涛,丁建勇,等. 胸腔镜与开放手术治疗临床早期胸腺恶性肿瘤的围手术期效果及长期生存率的比较[J]. 中国肺癌杂志, 2016, 19(7):453-458.
[14] Yuan ZY, Cheng GY, Sun KL, et al. Comparative study of video-assisted thoracic surgery versus open thymectomy for thymoma in one single center[J]. J Thorac Dis, 2014, 6(6):726-733.
[15] Odaka M, Shibasaki T, Asano H, et al. Feasibility of thoracoscopic thymectomy for treatment of early-stage thymoma[J]. Asian J Endosc Surg, 2016, 8(4):439-444.