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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13.	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.
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16.	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.
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1. Duwe BV, Sterman DH, Musani AI. Tumors of the mediastinum. Chest, 2005, 128(4): 2893-2909.
2. 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.
3. 吴成贵. 前纵隔肿瘤 CT 影像特征与鉴别诊断的价值. 中国卫生标准管理, 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. 张磊. 电视胸腔镜手术与传统手术治疗胸腺瘤的疗效比较. 医学信息, 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. 林经纬. 前纵隔肿瘤切除患者应用剑突下单孔胸腔镜手术对并发症和安全性的效果研究. 中外医学研究, 2019, 17(30): 3-5.
9. 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.
10. 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.
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. 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.
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. 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.
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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