摘要
目的比较常规开胸手术、胸腔镜(VATS)经肋间手术与VATS剑突下小切口手术治疗早期胸腺瘤的临床效果,探讨VATS剑突下小切口手术治疗双侧胸腺瘤的可行性及优越性。方法选取我院2014年1月~2017年6月符合Masaoka分期法Ⅰ~Ⅱ期诊断标准的62例胸腺瘤患者作为研究对象,根据手术方式不同进行分组。16例患者采用VATS经剑突下小切口手术,24例患者采用VATS经肋间手术,22例患者采用传统前正中切口胸骨劈开手术。比较三组患者的手术时间、术中出血量、引流时间、住院天数、疼痛程度、抗菌时间、并发症发生率、患者满意度等情况。结果 VATS经剑突下组的手术时间、术后引流时间、抗菌时间和术后住院天数短于VATS经肋间组与胸骨劈开组,术中出血量少于VATS经肋间组与胸骨劈开组,差异有统计学意义(P<0.05);三组患者的并发症发生率(6.25%、12.50%、18.18%)、满意度(81%、59%、42%)比较,差异有统计学意义(P<0.05),VATS经剑突下组优势明显。随访期间,三组患者均无复发和转移。结论 VATS剑突下小切口手术治疗双侧胸腺瘤能够减少手术创伤,降低并发症发生率,减轻患者痛苦,缩短患者住院时间,值得临床推广应用。
Objective To compare the clinical effects of routine thoracotomy,VATS intercostal surgery and VATS subxiphoid small incision in the treatment of early thymomas,and to investigate the feasibility and superiority of VATS subxiphoid small incision surgery for bilateral thymomas.Methods A total of 62 patients with thymoma who met the diagnosis criteria of phase Ⅰ-Ⅱ of the Masaoka staging method in our hospital from January 2014 to June 2017 were selected as the study subjects.They were assigned to different groups based on different surgical methods.A total of 16 patients were given VATS subxiphoid small incision surgery,24 patients were given VATS intercostal surgery,and 22 patients were given a traditional frontal and midline incision sternotomy.The surgery time,intraoperative blood loss,drainage time,length of stay,pain degree,antibacterial time,complication rate,and patient satisfaction were compared between the three groups.Results The operative time,postoperative drainage time,antibacterial time and postoperative hospitalization days in VATS subxiphoid group were shorter than those in VATS intercostal group and sternotomy group,the intraoperative blood loss in VATS subxiphoid group was less than that in VATS intercostal group and sternotomy group,with significant difference（P〈0.05）.The incidence rate of complications in the three groups was 6.25%,12.50%,18.18%,and satisfaction was 81%,59%,42%,and the differences were statistically significant（P〈0.05）.The advantage of VATS subxiphoid group was significant.During the follow-up period,no recurrence or metastasis was observed in all the three groups.Conclusion The VATS subxiphoid small incision in the treatment of bilateral thymoma reduces the surgical trauma,reduces the incidence rate of complications,alleviates the patient′s pain and shortens the hospital stay.It is worthy of clinical promotion and application.
作者
程少先
徐文礼
艾瑞华
张耀晴
廖永德
CHENG Shao-xian, XU Wen-li, AI Rui-hua, ZHANG Yao-qing, LIAO Yong-de2(l.The Second Department of General Surgery,Xiehe Jingshan Hospital of Huazhong University of Science and Technology,Hubei Province,Jingshan 431800,China;2.Department of Thoracic Surgery,Affiliated Tongji Hospital of Huazhong University of Science and Technology,Hubei Province,Wuhan 430030,Chin)
出处
《中国当代医药》
2018年第13期8-12,共5页
China Modern Medicine
基金
2017年度湖北省荆门市引导性科研计划项目
