Clinical analysis of thoracoscopic anterior mediastinal tumor resection in lithotomy position via subxiphoid approach or lateral position via transthoracic approach_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Renpeng , LI Yan , HU Wenteng , CAO Xiong , WANG Pengfei ,  HAN Biao

Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, P.R.China;

Corresponding?author：

HAN Biao, Email: hanbiao66@163.com

Keywords：

Mediastinal mass; lithotomy position; lateral position; video-assisted thoracoscopic surgery

DOI：

10.7507/1007-4848.201903020

Video：

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Objective To discuss the safety, feasibility and short-term clinical efficacy of thoracoscopic anterior mediastinal mass resection in lithotomy position via subxiphoid approach or lateral position via transthoracic approach.Methods A total of 44 patients suffering anterior mediastinal tumor enrolled, including 21 patients (10 males and 11 females as a trial group) with an average age of 43.6±11.8 years who have been performed thoracoscopic anterior mediastinal tumor resection in lithotomy position via subxiphoid approach and 23 patients (13 males and 10 females as a control group) with an average age of 45.3±10.8 years who have been performed thoracoscopic anterior mediastinal tumor resection in lateral position via transthoracic approach. The clinical efficacy of the two groups was compared.Results Postoperative chest drainage time (3.8±1.3 d vs. 5.0±1.8 d, P=0.017), postoperative drainage volume (238.8±66.2 mL vs. 467.2±120.0 mL, P=0.000), postoperative mean visual analogue score at 24 h (2.5±0.9 point vs. 4.9±1.0 point, P=0.000), times of self-pressure analgesic pump (3.7±0.9 vs. 8.4±2.0, P=0.000), duration of postoperative hospital stay (4.7±1.3 d vs. 7.4±3.1 d, P=0.000) and hospitalization cost (34±8 kyaun vs. 44±11 kyuan P=0.001) in the trial group were all better than those in the control group. There was no significant difference between the two groups in surgical duration (59.0±18.1 min vs. 60.4±16.4 min) (P>0.05). During follow-up, no recurrence or metastasis occurred in either group.Conclusion Compared with the lateral position through the transthoracic approach, the lithotomy position through subxiphoid approach of thoracoscopic anterior mediastinal mass resection is safe and feasible, and has certain advantages.

Citation： LI Renpeng, LI Yan, HU Wenteng, CAO Xiong, WANG Pengfei, HAN Biao. Clinical analysis of thoracoscopic anterior mediastinal tumor resection in lithotomy position via subxiphoid approach or lateral position via transthoracic approach. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(12): 1171-1175. doi: 10.7507/1007-4848.201903020 Copy

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2.	柏啟州, 于珺, 茍云久, 等. 達芬奇機器人手術療縱隔腫瘤的病例對照研究. 中國胸心血管外科臨床雜志, 2018, 25(5): 382-386.
3.	楊勝利, 茹婷巧, 楊劼, 等. 單操作孔全胸腔鏡手術在縱隔腫物切除中的應用. 華中科技大學學報(醫學版), 2015, 44(3): 330-333.
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6.	彭凱明, 康明強, 林濟紅, 等. 經劍突下胸腔鏡手術治療前縱隔腫瘤療效分析. 中華胸部外科電子雜志, 2018, 5(1): 16-21.
7.	Zahid I, Sharif S, Routledge T, et al. Video-assisted thoracos-Copic surgery or transsternal thymectomy in the treatment of myas-thenia gravis? Interact Cardiovasc Thorac Surg, 2011, 12(1): 40-46.
8.	Ng CS, Wan IY, Yim AP. Video-assisted thoracic surgery thymectomy: the better approach. Ann Thorac Surg, 2010, 89(6): S2135-S2141.
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11.	Ye B, Li W, Ge XX, et al. Surgical treatment of early-stage thymomas: Endosc robotassisted thoracoscopic surgery versus transster-nal thymectomy. Surg Endosc, 2014, 28(1): 122-126.
12.	Numanami H, Yano M, Yamaji M, et al. Thoracoscopic thymectomy using a subxiphoid approach for anterior mediastinal tumors. Ann Thorac Cardiovasc Surg, 2018, 24: 65-72.
13.	于文濱. 腔鏡甲狀腺手術中 CO₂充氣對大腦影響的實驗研究. 山東大學, 2009.
14.	唐渲, 梁毅. 經劍突下單孔胸腔鏡手術的臨床應用. 廣東醫學, 2016, 37(S1): 131-132.
15.	Gothard J. Lung injury after thoracic surgery and one-lung ventilation. Curr Opin Anaesthesiol, 2006, 19(1): 5-10.
16.	程少先, 徐文禮, 艾瑞華, 等. 胸腔鏡劍突下小切口治療雙側胸腺瘤的臨床效果. 中國當代醫藥, 2018, 25(13): 8-12.
17.	Suda T, Sugimura H, Tochii D, et al. Single-port thymectomy through an infrasternal approach. Ann Thorac Surg, 2012, 93(1): 334-336.
18.	Suda T, Ashikari S, Tochii D, et al. Dual-port thymectomy using subxiphoid approach. Gen Thorac Cardiovasc Surg, 2014, 62(9): 570-572.
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21.	梁寶磊, 蔡慶勇, 梁貴友, 等. 劍突下單孔胸腔鏡與雙側單孔胸腔鏡同期處理雙側肺大皰的對比研究. 中國微創外科雜志, 2018, 18(10): 881-884.
22.	宋陽, 陳剛, 伍寧, 等. 電視胸腔鏡與經胸骨胸腺切除治療不伴胸腺瘤重癥肌無力的臨床分析. 中華胸部外科電子雜志, 2015, 2(3): 182-187.

1. 趙輝, 劉軍, 李劍鋒, 等. 縱隔鏡手術在縱隔腫物診斷中的應用價值. 中國內鏡雜志, 2006, 12(9): 925-927.
2. 柏啟州, 于珺, 茍云久, 等. 達芬奇機器人手術療縱隔腫瘤的病例對照研究. 中國胸心血管外科臨床雜志, 2018, 25(5): 382-386.
3. 楊勝利, 茹婷巧, 楊劼, 等. 單操作孔全胸腔鏡手術在縱隔腫物切除中的應用. 華中科技大學學報(醫學版), 2015, 44(3): 330-333.
4. 孟慶軍, 孔繁義, 宋翔. 經劍突下及肋弓下切口胸腔鏡胸腺切除術的臨床分析. 中國胸心血管外科臨床雜志, 2018, 25(5): 449-452.
5. 葉鳳清, 高春霞, 蔣桂蓮, 等. 三種截石位擺放與復位方法的比較研究. 護理學雜志, 2014, 29(14): 36-38.
6. 彭凱明, 康明強, 林濟紅, 等. 經劍突下胸腔鏡手術治療前縱隔腫瘤療效分析. 中華胸部外科電子雜志, 2018, 5(1): 16-21.
7. Zahid I, Sharif S, Routledge T, et al. Video-assisted thoracos-Copic surgery or transsternal thymectomy in the treatment of myas-thenia gravis? Interact Cardiovasc Thorac Surg, 2011, 12(1): 40-46.
8. Ng CS, Wan IY, Yim AP. Video-assisted thoracic surgery thymectomy: the better approach. Ann Thorac Surg, 2010, 89(6): S2135-S2141.
9. Kondo K. Therapy for thymic epithelial tumors. Gen Thorac Cardio-vasc Surg, 2014, 62: 468-474.
10. Kimura T, Inoue M, Kadota Y, et al. The oncological feasibility and limitations of video-assisted thoracoscopic thymectomy for early-stage thymomas. Eur J Cardiothorac Surg, 2013, 44(3): 214-218.
11. Ye B, Li W, Ge XX, et al. Surgical treatment of early-stage thymomas: Endosc robotassisted thoracoscopic surgery versus transster-nal thymectomy. Surg Endosc, 2014, 28(1): 122-126.
12. Numanami H, Yano M, Yamaji M, et al. Thoracoscopic thymectomy using a subxiphoid approach for anterior mediastinal tumors. Ann Thorac Cardiovasc Surg, 2018, 24: 65-72.
13. 于文濱. 腔鏡甲狀腺手術中 CO₂充氣對大腦影響的實驗研究. 山東大學, 2009.
14. 唐渲, 梁毅. 經劍突下單孔胸腔鏡手術的臨床應用. 廣東醫學, 2016, 37(S1): 131-132.
15. Gothard J. Lung injury after thoracic surgery and one-lung ventilation. Curr Opin Anaesthesiol, 2006, 19(1): 5-10.
16. 程少先, 徐文禮, 艾瑞華, 等. 胸腔鏡劍突下小切口治療雙側胸腺瘤的臨床效果. 中國當代醫藥, 2018, 25(13): 8-12.
17. Suda T, Sugimura H, Tochii D, et al. Single-port thymectomy through an infrasternal approach. Ann Thorac Surg, 2012, 93(1): 334-336.
18. Suda T, Ashikari S, Tochii D, et al. Dual-port thymectomy using subxiphoid approach. Gen Thorac Cardiovasc Surg, 2014, 62(9): 570-572.
19. Suda T. Single-port thymectomy using a subxiphoid approach: surgical techni-que. Ann Cardiothorac Surg, 2016, 5(1): 56-58.
20. Gonzalez-Rivas D. Recent advances in uniportal video-assisted thoracoscopic surgery. Chin J Cancer Res, 2015, 27(1): 90-93.
21. 梁寶磊, 蔡慶勇, 梁貴友, 等. 劍突下單孔胸腔鏡與雙側單孔胸腔鏡同期處理雙側肺大皰的對比研究. 中國微創外科雜志, 2018, 18(10): 881-884.
22. 宋陽, 陳剛, 伍寧, 等. 電視胸腔鏡與經胸骨胸腺切除治療不伴胸腺瘤重癥肌無力的臨床分析. 中華胸部外科電子雜志, 2015, 2(3): 182-187.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical analysis of thoracoscopic anterior mediastinal tumor resection in lithotomy position via subxiphoid approach or lateral position via transthoracic approach

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