Clinical application of tubeless trans-subxiphoid thoracoscopic surgery in anterior mediastinal tumor resection: A case control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YUE Hanxun ¹ , ZHANG Yu ¹ , MA Minjie ¹ , WEI Ning ¹ , HUO Bin ² , LIN Ruijiang ¹ ,  HAN Biao ¹

1. Department of Thoracic Surgery, Lanzhou University First Hospital, Lanzhou, 730000, P.R.China;
2. Department of Anesthesiology, Lanzhou University First Hospital, Lanzhou, 730000, P.R.China;

Corresponding author：

HAN Biao, Email: hanbiao66@163.com

Keywords：

Spontaneous breathing anesthesia; enhanced recovery after surgery; thoracoscopy; mediastinal tumor

DOI：

10.7507/1007-4848.201808001

Video：

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Objective To discuss the safety, feasibility and advantages of tubeless trans-subxiphoid thoracoscopic surgery in anterior mediastinal tumor resection. Methods A total of 32 patients suffering anterior mediastinal tumor were enrolled, including 17 patients (8 males and 9 females) with average age of 31.8±8.4 years who had been performed tubeless trans-subxipohoid tharcoscopic surgery and 15 patients (8 males and 7 females) with average age of 31.1±9.2 years who had been performed traditional trans-subxipohoid tharcoscopic surgery. The differences of surgical duration, the lowest intraoperative arterial oxygen saturation (SaO₂), postoperative awaking time, postoperative pain visual analogue score (VAS), postoperative pulmonary recruitment time, duration of postoperative hospital stay and hospitalization cost were analyzed. Results Postoperative awaking time (18.5±1.8 min vs. 28.9±4.2 min, P=0.000), postoperative VAS (1.6±0.6 vs. 3.5±7.4, P=0.000), duration of postoperative hospital stay (2.5±7.2 d vs. 4.3±1.1 d, P=0.000) and hospitalization cost (3.2±1.1 ten thousand RMB vs. 4.9±1.1 10 ten thousand RMB, P=0.000) in the tubeless group were better than those in the control group. There was no significant difference in surgical duration (51.7±6.5 min vs. 55.1±8.5 min), the lowest intraoperative SaO₂ (98.5%±0.9% vs. 98.1%±0.8%), postoperative pulmonary recruitment time (33.9±12.2 d vs. 38.4±15.2 d, P>0.05) between the two groups.Conclusion Tubeless trans-subxiphoid thoracoscopic surgery is safe, feasible and advanced in anterior mediastinal tumor resection.

Citation： YUE Hanxun, ZHANG Yu, MA Minjie, WEI Ning, HUO Bin, LIN Ruijiang, HAN Biao. Clinical application of tubeless trans-subxiphoid thoracoscopic surgery in anterior mediastinal tumor resection: A case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(4): 353-357. doi: 10.7507/1007-4848.201808001 Copy

1.	彭凯明, 康明强, 林济红, 等. 经剑突下胸腔镜手术治疗前纵隔肿瘤疗效分析. 中华胸部外科电子杂志, 2018, 5(1): 16-21.
2.	孟庆军, 孔繁义, 宋翔. 经剑突下及肋弓下切口胸腔镜胸腺切除术的临床分析. 中国胸心血管外科临床杂志, 2018, 25(5): 449-452.
3.	程少先, 徐文礼, 艾瑞华, 等. 胸腔镜剑突下小切口治疗双侧胸腺瘤的临床效果. 中国当代医药, 2018, 25(13): 8-12.
4.	张进, 杨鲲鹏, 王旭广, 等. 胸腺切除术后不放置胸腔及纵隔引流可行性的研究. 中国现代手术学杂志, 2012, 16(2): 112-114.
5.	陈舒晨, 余绍斌, 林济红, 等. 经剑突下入路胸腔镜下前纵隔肿瘤切除术学习曲线分析. 福建医科大学学报, 2017, 51(5): 311-315.
6.	Xia Z, Qiao K, He J. Recent advances in the management of pulmonary tuberculoma with focus on the use of tubeless video-assisted thoracoscopic surgery. J Thorac Dis, 2017, 9(9): 3307-3312.
7.	Cui F, Liu J, Li S, et al. Tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of chest tube postoperatively. J Thorac Dis, 2016, 8(8): 2226-2232.
8.	钟斌, 吴奇勇, 童继春, 等. 剑突下入路胸腔镜下前纵隔肿瘤摘除术 16 例报告. 实用临床医药杂志, 2017, 21(19): 119-120.
9.	张勇, 王哲, 张广健, 等. 经剑突下胸腔镜技术在前纵隔肿瘤外科治疗中的应用. 现代肿瘤医学, 2017, 25(11): 1731-1733.
10.	方泽民, 王跃斌, 丁志丹, 等. 剑突下单孔胸腔镜手术在前纵隔肿瘤治疗中的应用. 河南医学研究, 2018, 27(5): 890-891.
11.	张科, 童继春, 吴奇勇. 经剑突下胸腔镜技术在胸腺瘤切除术中的应用. 中国微创外科杂志, 2018, 18(2): 107-109.
12.	Gothard J. Lung injury after thoracic surgery and one-lung ventilation. Curr Opin Anaesthesiol, 2006, 19(1): 5-10.
13.	周一凡, 钟永泷, 林辉, 等. 经剑突入路胸腔镜胸腺扩大切除治疗重症肌无力的临床分析. 中国胸心血管外科临床杂志, 2017, 24(4): 318-320.
14.	Blanchet MC, Frering V, Gignoux B, et al. Four-Year Evolution of a thrombophylaxis protocol in an enhanced recovery after surgery (ERAS) program: Recent results in 485 patients. Obes Surg, 2018. doi: 10.1007/s11695-018-3299-4.[Epub ahead of print].
15.	蔡开灿, 王向东, 叶靖, 等. 喉罩全麻与气管插管全麻胸腔镜手术治疗肺大疱的临床对照研究. 南方医科大学学报, 2013, 33(5): 756-760.
16.	Boisen ML, Rao VK, Kolarczyk L, et al. The Year in Thoracic Anesthesia: Selected Highlights from 2016. J Cardiothorac Vasc Anesth, 2017, 31(3): 791-799.
17.	Feneley RC, Hopley IB, Wells PN. Urinary catheters: history, current status, adverse events and research agenda. J Med Eng Technol, 2015, 39(8): 459-470.
18.	张满, 靳智勇, 马英, 等. 自主呼吸麻醉结合单孔非置管胸腔镜技术在肺大疱切除术中应用的随机对照试验. 中国胸心血管外科临床杂志, 2018, 25(3): 218-221.
19.	Peng G, Liu M, Luo Q, et al. Spontaneous ventilation anesthesia combined with uniportal and tubeless thoracoscopic lung biopsy in selected patients with interstitial lung diseases. J Thorac Dis, 2017, 9(11): 4494-4501.
20.	Li S, Jiang L, Ang KL, et al. New tubeless video-assisted thoracoscopic surgery for small pulmonary nodules. Eur J Cardiothorac Surg, 2017, 51(4): 689-693.
21.	Gonzalez-Rivas D, Yang Y, Guido W, et al. Non-intubated (tubeless) uniportal video-assisted thoracoscopic lobectomy. Ann Cardiothorac Surg, 2016, 5(2): 151-153.
22.	Gonzalez-Rivas D, Bonome C, Fieira E, et al. Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery? Eur J Cardiothorac Surg, 2016, 49(3): 721-731.
23.	Watanabe A, Watanabe T, Ohsawa H, et al. Avoiding chest tube placement after video-assisted thoracoscopic wedge resection of the lung. Eur J Cardiothorac Surg, 2004, 25(5): 872-876.
24.	Holbek BL, Hansen HJ, Kehlet H, et al. Thoracoscopic pulmonary wedge resection without post-operative chest drain: an observational study. Gen Thorac Cardiovasc Surg, 2016, 64(10): 612-617.
25.	袁江, 张永学, 高兆明. 剑突下单孔胸腔镜与三孔胸腔镜前纵隔肿瘤切除的临床疗效对比. 中国老年学杂志, 2017, 37(15): 3815-3817.

1. 彭凯明, 康明强, 林济红, 等. 经剑突下胸腔镜手术治疗前纵隔肿瘤疗效分析. 中华胸部外科电子杂志, 2018, 5(1): 16-21.
2. 孟庆军, 孔繁义, 宋翔. 经剑突下及肋弓下切口胸腔镜胸腺切除术的临床分析. 中国胸心血管外科临床杂志, 2018, 25(5): 449-452.
3. 程少先, 徐文礼, 艾瑞华, 等. 胸腔镜剑突下小切口治疗双侧胸腺瘤的临床效果. 中国当代医药, 2018, 25(13): 8-12.
4. 张进, 杨鲲鹏, 王旭广, 等. 胸腺切除术后不放置胸腔及纵隔引流可行性的研究. 中国现代手术学杂志, 2012, 16(2): 112-114.
5. 陈舒晨, 余绍斌, 林济红, 等. 经剑突下入路胸腔镜下前纵隔肿瘤切除术学习曲线分析. 福建医科大学学报, 2017, 51(5): 311-315.
6. Xia Z, Qiao K, He J. Recent advances in the management of pulmonary tuberculoma with focus on the use of tubeless video-assisted thoracoscopic surgery. J Thorac Dis, 2017, 9(9): 3307-3312.
7. Cui F, Liu J, Li S, et al. Tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of chest tube postoperatively. J Thorac Dis, 2016, 8(8): 2226-2232.
8. 钟斌, 吴奇勇, 童继春, 等. 剑突下入路胸腔镜下前纵隔肿瘤摘除术 16 例报告. 实用临床医药杂志, 2017, 21(19): 119-120.
9. 张勇, 王哲, 张广健, 等. 经剑突下胸腔镜技术在前纵隔肿瘤外科治疗中的应用. 现代肿瘤医学, 2017, 25(11): 1731-1733.
10. 方泽民, 王跃斌, 丁志丹, 等. 剑突下单孔胸腔镜手术在前纵隔肿瘤治疗中的应用. 河南医学研究, 2018, 27(5): 890-891.
11. 张科, 童继春, 吴奇勇. 经剑突下胸腔镜技术在胸腺瘤切除术中的应用. 中国微创外科杂志, 2018, 18(2): 107-109.
12. Gothard J. Lung injury after thoracic surgery and one-lung ventilation. Curr Opin Anaesthesiol, 2006, 19(1): 5-10.
13. 周一凡, 钟永泷, 林辉, 等. 经剑突入路胸腔镜胸腺扩大切除治疗重症肌无力的临床分析. 中国胸心血管外科临床杂志, 2017, 24(4): 318-320.
14. Blanchet MC, Frering V, Gignoux B, et al. Four-Year Evolution of a thrombophylaxis protocol in an enhanced recovery after surgery (ERAS) program: Recent results in 485 patients. Obes Surg, 2018. doi: 10.1007/s11695-018-3299-4.[Epub ahead of print].
15. 蔡开灿, 王向东, 叶靖, 等. 喉罩全麻与气管插管全麻胸腔镜手术治疗肺大疱的临床对照研究. 南方医科大学学报, 2013, 33(5): 756-760.
16. Boisen ML, Rao VK, Kolarczyk L, et al. The Year in Thoracic Anesthesia: Selected Highlights from 2016. J Cardiothorac Vasc Anesth, 2017, 31(3): 791-799.
17. Feneley RC, Hopley IB, Wells PN. Urinary catheters: history, current status, adverse events and research agenda. J Med Eng Technol, 2015, 39(8): 459-470.
18. 张满, 靳智勇, 马英, 等. 自主呼吸麻醉结合单孔非置管胸腔镜技术在肺大疱切除术中应用的随机对照试验. 中国胸心血管外科临床杂志, 2018, 25(3): 218-221.
19. Peng G, Liu M, Luo Q, et al. Spontaneous ventilation anesthesia combined with uniportal and tubeless thoracoscopic lung biopsy in selected patients with interstitial lung diseases. J Thorac Dis, 2017, 9(11): 4494-4501.
20. Li S, Jiang L, Ang KL, et al. New tubeless video-assisted thoracoscopic surgery for small pulmonary nodules. Eur J Cardiothorac Surg, 2017, 51(4): 689-693.
21. Gonzalez-Rivas D, Yang Y, Guido W, et al. Non-intubated (tubeless) uniportal video-assisted thoracoscopic lobectomy. Ann Cardiothorac Surg, 2016, 5(2): 151-153.
22. Gonzalez-Rivas D, Bonome C, Fieira E, et al. Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery? Eur J Cardiothorac Surg, 2016, 49(3): 721-731.
23. Watanabe A, Watanabe T, Ohsawa H, et al. Avoiding chest tube placement after video-assisted thoracoscopic wedge resection of the lung. Eur J Cardiothorac Surg, 2004, 25(5): 872-876.
24. Holbek BL, Hansen HJ, Kehlet H, et al. Thoracoscopic pulmonary wedge resection without post-operative chest drain: an observational study. Gen Thorac Cardiovasc Surg, 2016, 64(10): 612-617.
25. 袁江, 张永学, 高兆明. 剑突下单孔胸腔镜与三孔胸腔镜前纵隔肿瘤切除的临床疗效对比. 中国老年学杂志, 2017, 37(15): 3815-3817.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical application of tubeless trans-subxiphoid thoracoscopic surgery in anterior mediastinal tumor resection: A case control study

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