摘要
目的对比分析经不同入路行单孔胸腔镜胸腺扩大切除术疗效的安全性及优势。方法回顾性收集2018年1月至2022年9月期间因胸腺瘤在三亚中心医院(海南省第三人民医院)胸心外科行单孔胸腔镜胸腺扩大切除术的患者192例。按照手术不同入路方式分为经侧胸入路组(LASP)和经剑突下入路组(SASP),其中肋间组65例,剑突下组127例。对两组基线资料通过倾向性评分匹配法进行匹配分析,最终筛选出106例患者,每组各53例。对比分析SASP和LASP两组患者手术时间、术中出血计量、中转开胸例数、术后引流量、胸腔引流管留置时间、术后不同时间切口疼痛视觉模拟评分(VAS)等指标。结果经倾向性评分匹配后,共106例患者匹配成功。两组患者各类基线资料经过匹配后差异均无统计学意义(P>0.05)。LASP组手术时间少于SASP组[(103.453±25.992)min比(114.509±25.142)min],差异有统计学意义(P<0.05);术中出血量[60(45~90)mL比55(45~65)mL]、术后第1天疼痛VAS评分[5(5~6)比5(4~5)]两组间无统计学意义;拔管后疼痛VAS评分[4(3~5)比4(3~4)]、术后1周疼痛VAS评分[2(1~3)比1(0~2)]、术后1周需要镇痛药物各项数据SASP组均优于LALP组,且差异具有统计学意义(P<0.05);术后胸腔引流量、引流管置管时间、拔管后需要镇痛药物等数据两组差异无统计学意义(P>0.05)。结论侧胸与剑突下入路行胸腺扩大切除均安全有效,剑突下入路手术耗时更长,但具有术后疼痛轻的优点。
Objective To compare the safety and advantages of uniportal thoracoscopic thymectomy by different approaches.Methods One hundred and ninety-two patients with thymoma who underwent uniportal thoracoscopic thymectomy from January 2018 to September 2022 in Department of Cardiothoracic Surgery of Sanya Central Hospital(The Third People’s Hospital of Hainan)were retrospectively collected.An lateral group(LASP)with 65 cases and a subxiphoid group(SASP)with 127 cases were assigned,and finally 53 cases were matched in each group by propensity score matching.The indicators,including operative time,intraoperative blood loss,number of conversions to open surgery,postoperative drainage volume,chest tube indwelling time,and postoperative wound pain VAS scores at different time points,were compared and analyzed in the SASP and LASP groups.Results A total of 106 patients were successfully matched.There was no significant difference in baseline data after matching(P>0.05).The operation time for the LASP group was shorter than that for the SASP group[(103.453±25.992)min vs(114.509±25.142)min,P<0.05].There was no statistical significance between the two groups in terms of intraoperative blood loss[60(45~90)mL vs 55(45~65)mL]and VAS score[5(5~6)vs 5(4~5)]on the first day after surgery.The VAS score after extubation[4(3~5)vs 4(3~4)],one week after the operation[2(1~3)vs 1(0~2)],and the need for analgesic drugs in the first week after surgery were better in the SASP group than in the LASP group(P<0.05).There was no significant difference between the two groups in the data of postoperative drainage volume,drainage time,and the need for analgesic drugs after extubation(P>0.05).Conclusion Both the lateral thorax and the subxiphoid approach are safe and effective.The subxiphoid approach has a longer operation time,but it has the advantage of less postoperative pain.
作者
苏永超
黎振龙
Su Yongchao;Li Zhenlong(Department of Cardiothoracic Surgery,Sanya Central Hospital(The Third People’s Hospital of Hainan),Sanya 572000,China)
出处
《中华胸部外科电子杂志》
2025年第3期130-135,共6页
CHINESE JOURNAL OF THORACIC SURGERY:Electronic Edition
