单孔与三孔剑突下胸腔镜全胸腺切除术的回顾性队列研究

目的比较单孔与三孔剑突下胸腔镜(subxiphoid video-assisted thoracoscopic surgery,XVATS)全胸腺切除术的临床特点。方法回顾性分析2017年1月至2019年5月在徐州市中心医院连续开展的60例XVATS全胸腺切除术患者的临床资料,其中男29例、女31例,年龄53.1(27.0~76.0)岁。依据手术方式不同分为单孔XVATS组(30例)与三孔XVATS组(30例)。比较两组临床效果。结果两组患者年龄、性别、体重指数、肿瘤长径、术中出血量、术后胸腔引流管留置时间、胸腔引流量与术后住院时间等差异无统计学意义(P均>0.05)。全组无围手术期死亡、中转开胸、血栓或纵隔感染病例。单孔XVATS组患者手术时间显著长于三孔XVATS组,差异有统计学意义(87.5±19.0)min vs.(75.8±15.7)min,P=0.012];此外,单孔组术后3~14 d疼痛评分显著低于三孔XVATS组(P=0.001)。结论单孔XVATS全胸腺切除术是可行的,患者术后疼痛较三孔组患者轻,但开展初期手术时间较长。

Uniportal versus three-port subxiphoid video-assisted thoracoscopic extended thymectomy:A retrospective cohort study

Objective To investigate the clinical characteristics of uniportal and three-port subxiphoid videoassisted thoracoscopic surgery(XVATS)extended thymectomy.Methods The clinical data of 60 consecutive patients of XVATS thymectomy in Xuzhou Central Hospital from January 2017 to May 2019 were retrospectively analyzed.There were 29 males and 31 females,with an average age of 53.1(27.0-76.0)years.The patients were divided into an uniportal XVATS group(30 patients)and a three-port XVATS group(30 patients).The clinical effectiveness was compared between the two groups.Results There was no significant difference in age,sex,body mass index,tumor size,intraoperative blood loss,postoperative time of thoracic tube indwelling and thoracic drainage,or postoperative hospitalization time between the two groups(P>0.05).There was no perioperative mortality,conversion to thoracotomy,thrombosis or mediastinal infection.The operation time of the uniportal XVATS group was significantly longer than that of the threeport group(87.5±19.0 min vs.75.8±15.7 min,P=0.012).Besides,patients in the uniportal group had significantly lower pain score during 3-14 postoperative days than that of the three-port group(P=0.001).Conclusion Uniportal XVATS extended thymectomy is feasible with less pain as compared with the patients using three-port XVATS,but it needs longer operation time at initial stage.