Clinical analysis of thoracoscopic treatment for anterior mediastinal tumor via subxiphoid approach under scissors position and lateral thoracic approach under lateral position_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

PAN Yuetian , SONG Yongbin ,  LIU Lijun

Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, 050000, P.R.China;

Corresponding?author：

LIU Lijun, Email: 13833131067@163.com

Keywords：

Anterior mediastinal tumor; scissors position; subxiphoid approach; thoracoscope; postoperative pain; surgery

DOI：

10.7507/1007-4848.201912019

Video：

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Objective To investigate the safety and feasibility of thoracoscopic surgery of anterior mediastinal tumors via subxiphoid approach under scissors position (SASP) and lateral thoracic approach under lateral position (LALP).Methods Clinical data of 69 patients who received anterior mediastinal tumor excision surgery in our hospital from June 2016 to November 2019 were retrospectively analyzed, including 32 males and 37 females with an average age of 46.38±11.52 years. The clinical effects of the two groups were compared.Results There was no perioperative death or conversion to thoracotomy. There was no statistically significant difference between the two groups in the operative time (123.34±12.64 min vs. 125.05±17.02 min, P=0.642), intraoperative blood loss [50.00 (73.75) mL vs. 50.00 (80.00) mL, P=0.643], tumor diameter (2.75±0.57 cm vs. 2.89±0.45 cm, P=0.787) and total hospital expenses [32.70 (5.30) thousand yuan vs. 32.90 (4.80) thousand yuan, P=0.923]. However, the postoperative catheterization time [2.00 (1.00) d vs. 4.00 (1.50) d, P=0.000], postoperative drainage [260.00 (200.00) mL vs. 400.00 (225.00) mL, P=0.031], postoperative pain index [2.00 (1.00) points vs. 4.00 (2.00) points, P=0.000], postoperative analgesic time [1.50 (1.00) d vs. 3.00 (2.00) d, P=0.000], postoperative fever time [1.50 (1.00) d vs. 2.00 (1.00) d, P=0.000] in the SASP group were better than those in the LALP group.Conclusion Thoracoscopic surgery via SASP is more suitable for the treatment of anterior mediastinal tumor with rapid postoperative recovery and reduced pain, and the postoperative curative effect is definite. However, there is a high requirement for the surgical experience and techniques. It can be promoted in the clinic.

Citation： PAN Yuetian, SONG Yongbin, LIU Lijun. Clinical analysis of thoracoscopic treatment for anterior mediastinal tumor via subxiphoid approach under scissors position and lateral thoracic approach under lateral position. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(10): 1172-1176. doi: 10.7507/1007-4848.201912019 Copy

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11.	Hsu CP. Subxiphoid approach for thoracoscopic thymectomy. Surg Endosc, 2002, 16(7): 1105.
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16.	張科, 童繼春, 吳奇勇. 經劍突下胸腔鏡技術在胸腺瘤切除術中的應用. 中國微創外科雜志, 2018, 18(2): 107-109.
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1. Duwe BV, Sterman DH, Musani AI. Tumors of the mediastinum. Chest, 2005, 128(4): 2893-2909.
2. 鐘斌, 吳奇勇, 童繼春, 等. 劍突下入路胸腔鏡下前縱隔腫瘤摘除術 16 例報告. 實用臨床醫藥雜志, 2017, 21(19): 119-120.
3. 吳成貴. 前縱隔腫瘤 CT 影像特征與鑒別診斷的價值. 中國衛生標準管理, 2017, 8(14): 116-117.
4. Jurado J, Javidfar J, Newmark A, <italic>et al</italic>. Minimally invasive thymectomy and open thymectomy: outcome analysis of 263 patients. Ann Thorac Surg, 2012, 94(3): 974-981.
5. 張磊. 電視胸腔鏡手術與傳統手術治療胸腺瘤的療效比較. 醫學信息, 2019, 24: 90-91.
6. Raza A, Woo E. Video-assisted thoracoscopic surgery versus sternotomy in thymectomy for thymoma and myasthenia gravis. Ann Cardiothorac Surg, 2016, 5(1): 33-37.
7. Blanchet MC, Frering V, Gignoux B, <italic>et al</italic>. Four-year evolution of a thrombophylaxis protocol in an enhanced recovery after surgery (ERAS) program: Recent results in 485 patients. Obes Surg, 2018, 28(7): 2140-2144.
8. 林經緯. 前縱隔腫瘤切除患者應用劍突下單孔胸腔鏡手術對并發癥和安全性的效果研究. 中外醫學研究, 2019, 17(30): 3-5.
9. 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.
10. 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.
11. Hsu CP. Subxiphoid approach for thoracoscopic thymectomy. Surg Endosc, 2002, 16(7): 1105.
12. Zielinski M, Hauer L, Hauer J, <italic>et al</italic>. Comparison of complete remission rates after 5 year follow-up of three different techniques of thymectomy for myasthenia gravis. Eur J Cardiothorac Surg, 2010, 37(5): 1137-1143.
13. 張進, 楊鯤鵬, 王旭廣, 等. 胸腺切除術后不放置胸腔及縱隔引流可行性的研究. 中國現代手術學雜志, 2012, 16(2): 112-114.
14. Suda T, Sugimura H, Tochii D, <italic>et al</italic>. Single-port thymectomy through an infrasternal approach. Ann Thorac Surg, 2012, 93(1): 334-336.
15. Suda T, Kaneda S, Hachimaru A, <italic>et al</italic>. Thymectomy via a subxiphoid approach: single-port and robot-assisted. J Thorac Dis, 2016, 8(Suppl 3): S265-S271.
16. 張科, 童繼春, 吳奇勇. 經劍突下胸腔鏡技術在胸腺瘤切除術中的應用. 中國微創外科雜志, 2018, 18(2): 107-109.
17. Zieliński M, Rybak M, Wilkojc M, <italic>et al</italic>. Subxiphoid video-assisted thorascopic thymectomy for thymoma. Ann Cardiothorac Surg, 2015, 4(6): 564-566.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical analysis of thoracoscopic treatment for anterior mediastinal tumor via subxiphoid approach under scissors position and lateral thoracic approach under lateral position

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