Comparison of Short-Term Efficacy of Mediastinal Tumor Resection via Subcostal Incision and Intercostal Approach under Thoracoscope
Objective:To compare the short-term efficacy of video-assisted thoracoscopic(VATS)trans-xiphoid subcostal and intercostal approaches for mediastinal tumor resection.Methods:A total of 157 patients who underwent thoracoscopic mediastinal tumor resection via the xiphoid process or intercostal ap-proach in the Department of Cardiothoracic Surgery,the First Affiliated Hospital of Guangxi Medical University from January 2019 to January 2022 were selected.They were divided into the xiphoid process group(n=56)or intercostal group(n=102)according to the surgical approach.After propensity score matching,52 patients were included in each group.The two groups were compared for surgery-related indicators[postoperative chest drainage volume,intraoperative blood loss,drainage tube indwelling time,operation time,bed rest time,number of self-pressing analgesia pumps,and hospitalization costs],postoperative complication rate,and pain level.Serum myoglobin(Mb),nerve growth factor(NGF),creatine phosphokinase(CPK),and prostaglandin E2(PGE2)levels were measured using electrochemiluminescence and enzyme-linked immu-nosorbent assay before surgery,and on days 1,3,and 5 after surgery.Results:The indwelling time of drain-age tube(2.37±1.05)days,bed rest time(1.37±0.65)days,hospitalization time(6.07±1.82)days,in-traoperative blood loss(72.26±9.41)ml,chest drainage volume(248.74±80.41)ml,the number of times of self-pressing the analgesia pump(3.72±0.98)times,and hospitalization costs(3.10±0.84)million yuan in the xiphoid group were less than those in the intercostal group(3.02±1.31)days,(1.92±0.70)days,(7.31±2.13)days,(85.33±12.69)ml,(325.96±95.22)ml,(8.41±2.17)times,and(3.76±1.22)million yuan(t=2.792,4.152,3.192,5.966,4.468,14.204,3.213,P<0.05);at 1 d,3 d and 5 d af-ter surgery,Mb,CPK,NGF and PGE2 in the xiphoid group were lower than those in the intercostal group(P<0.05);at 1 d,7 d and 1 month,3 months after surgery,the pain VAS scores in the xiphoid group were lower than those in the intercostal group(P<0.05);the incidence of complications in the xiphoid group was 1.92%(1/52),which was lower than that in the intercostal group(17.31%)(χ2 = 7.081,P<0.05).Conclusion:Compared with thoracoscopic transcostal approach,transxiphoid subcostal approach for mediasti-nal mass resection can significantly reduce the degree of muscle injury and pain in patients,and the operation is safe and reliable,conducive to postoperative recovery of patients,and the hospitalization cost is relatively low.
万方数据
维普
