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中华胸部外科电子杂志 ›› 2019, Vol. 06 ›› Issue (03) : 152 -155. doi: 10.3877/cma.j.issn.2095-8773.2019.03.03

论著

剑突下胸腔镜前纵隔肿瘤切除术初步应用分析
俞秋华1, 姜敏炎1, 吕亚军1, 黄骏1, 朱小波1, 蒋锋1, 王强1,   
  1. 1.213000 常州市武进人民医院胸外科
  • 收稿日期:2018-11-30 出版日期:2019-08-28
  • 通信作者: 王强
  • 基金资助:
    江苏省自然科学基金项目(BK20151175)

A preliminary application analysis of the subxiphoid approach in video-assistedthoracoscopicresection of anterior mediastinal tumor

Qiuhua Yu1, Mingyan Jiang1, Yajun Lv1, Jun Huang1, Xiaobo Zhu1, Feng Jiang1, Qiang Wang1,   

  1. 1.Department of Thoracic Surgery,Wuj in People's Hospital of Changzhou,Changzhou 213000,China
  • Received:2018-11-30 Published:2019-08-28
  • Corresponding author: Qiang Wang
引用本文:

俞秋华, 姜敏炎, 吕亚军, 黄骏, 朱小波, 蒋锋, 王强. 剑突下胸腔镜前纵隔肿瘤切除术初步应用分析[J/OL]. 中华胸部外科电子杂志, 2019, 06(03): 152-155.

Qiuhua Yu, Mingyan Jiang, Yajun Lv, Jun Huang, Xiaobo Zhu, Feng Jiang, Qiang Wang. A preliminary application analysis of the subxiphoid approach in video-assistedthoracoscopicresection of anterior mediastinal tumor[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2019, 06(03): 152-155.

目的

探讨剑突下胸腔镜前纵隔肿瘤切除术的临床应用价值。

方法

2016年1月至2019年6月,对收治的前纵隔肿瘤患者23 例行手术治疗,其中行单侧胸腔镜手术18 例(对照组),行剑突下胸腔镜手术5 例(研究组)。

结果

两组患者均按预定方式顺利完成手术,其中研究组1 例出现纵隔肿瘤侵犯左上肺,同时行左上肺楔形切除术。两组患者的术中出血量、住院时间、术后引流管留置时间均无明显差异(P>0 .05),手术时间有明显差异(P<0 .05),术后24h 疼痛评分有明显差异(P<0 .05)。患者均无术后出血二次开胸手术,对照组1 例出现术后左侧眼睑下垂,随访后有好转。

结论

剑突下胸腔镜前纵隔肿瘤切除术安全、可行,具有明显优势,值得推广、普及。

Objective

To evaluate the clinical value of subxiphoid approach in videoassistedthoracoscopicresection of anterior mediastinal tumor .

Methods

From January 2016 to June 2019 ,23 patients with anterior mediastinal tumor all underwent thoracoscopic tumorresection surgeries ,among which 18 patients received unilateral thoracoscopic surgery (control group) and 5 patients received subxiphoidthoracoscopic surgery ( research group) .

Results

All the patients in the two groups successfully completed the operation according to their predetermined method .One case in the research group suffered mediastinal tumorsencroaching on the left upperlung , and wedge resection of the left upper lung was performed at the same time .There was no significant difference in intraoperative blood loss ,length of hospital stay , and drainage tube indwelling time between the two groups ( P>0 .05) ,however ,there were significant differences in operative time ( P<0 .05) ,and postoperative pain score at 24 h ( P<0 .05) .None of the patients underwent postoperative bleeding and secondary thoracotomy ,and one patient in the control group got postoperative left eyelid droop , whichimproved after follow-up .

Conclusions

The subxiphoid approach in video-assistedthoracoscopicresection of anterior mediastinal tumor is safe ,feasible and has obvious advantages and shall be popularized .

图1 剑突下胸腔镜手术切口,其中红色箭头指向双侧肋缘下切口
表1 两组患者临床资料比较(±s)
1
Kondo K , Monden Y . Therapy for thymic epithelial tumors : a clinical study of 1 ,320 patients from Japan[J] . Ann Thorac Surg ,2003 ,76(3) :878-884 .
2
Chen H , Xu G , Zheng W , et al . Video-assisted thoracoscopic extended thymectomy using the subxiphoid approach[J] . J Vis Surg ,2016 ,2 :157 .
3
Suda T , Hachimaru A , Tochii D , et al . Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy :initial resultsdagger[J] .Eur J Cardiothorac Surg ,2016 ,49 (Suppl 1) :i54-i58 .
4
Zielinski M , Czajkowski W , Gwozdz P , et al . Resection of thymomas with use of the new minimally-invasive technique of extended thymectomy performed through the subxiphoid-right video-thoracoscopic approach with double elevation of the sternum[J] . Eur J Cardiothorac Surg ,2013 ,44(2) :e113-119 .
5
Yano M , Moriyama S , Haneda H , et al . The subxiphoid approach leads to less invasive thoracoscopic thymectomy than the lateral approach[J] . World J Surg ,2017 ,41(3) :763-770 .
6
Suda T . Subxiphoid thymectomy : single-port , dual-port , and robot-assisted[J] . J Vis Surg , 2017 ,3 :75 .
7
Chiu CH , Chao YK , Liu Y H . Subxiphoid approach for videoassisted thoracoscopic surgery : an update[J] . J T horac Dis ,2018 ,10(Suppl 14) :S1662-S1665 .
8
Numanami H , Yano M , Yamaji M , et al . T horacoscopic thymectomy using a subxiphoid approach for anterior mediastinal tumors[J] . Ann Thorac Cardiovasc Surg ,2018 ,24(2) :65-72 .
9
Suda T , Kaneda S , Hachimaru A , et al . T hymectomy via a subxiphoid approach : single-port and robot-assisted [ J ] . J T horac Dis ,2016 ,8(Suppl 3) :S265-271 .
10
Luo T , Zhao H , Zhou X . The clinical features , diagnosis and management of recurrent thymoma[J] . J Cardiothorac Surg ,2016 ,11(1) :140 .
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
Hsu CP ,Chuang CY , Hsu NY ,et al .Comparison between the right side and subxiphoid bilateral approaches in performing video-assisted thoracoscopic extendedthymectomyfor myasthenia gravis[J] .Surg Endosc ,2004 ,18(5) :821-824 .
13
Suda T , Ashikari S , Tochii D , et al . Dual-port thymectomy using subxiphoid approach[J] . Gen Thorac Cardiovasc Surg ,2014 ,62(9) :570-572 .
14
付金松,杨刚,郑献身,等.剑突下单孔胸腔镜肺大疱手术疗效随机对照研究[J] .临床肺科杂志,2018 ,23(12) :2234-2238 .
15
Abu-Akar F , Gonzalez-Rivas D , Yang C , et al . Subxiphoid uniportal VA TS for thymic and combined mediastinal and pulmonary resections - atwo-year experience[J] . Semin Thorac Cardiovasc Surg ,2019 ,31(3) :614-619 .
16
Martinez-Tellez E , Trujillo-Reyes JC , Guarino M , et al .Subxiphoid video-thoracoscopy [ J] . J T horac Dis , 2018 ,10(Suppl 22) :S2643-S2648 .
17
Suda T , Tochii D , Tochii S , et al . Trans-subxiphoid robotic thymectomy[J] .Interact Cardiovasc Thorac Surg ,2015 ,20(5) :669-671 .
18
Zhang H ,Chen L ,Zheng Y ,et al .Robot-assisted thymectomy via subxiphoid approach : technical details and early outcomes[J] .J Thorac Dis ,2018 ,10(3) :1677-1682 .
19
郭少鸣,蒋家好,金淳,等.改良剑突下入路胸腔镜前纵隔畸胎瘤切除术的临床应用分析[J] .中国临床医学,2019 ,26(1):43-45 .
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