Clinical Analysis of 42 Cases of Anterior Mediastinal Tumor Resection by Thoracoscopic"Three Hole"Approach under Xiphoid Costal Margin
经剑突肋缘下“三孔式”入路胸腔镜下前纵隔肿瘤切除术42例临床分析

摘要

目的：探讨经剑突肋缘下“三孔式”入路胸腔镜下治疗前纵隔肿瘤的手术安全性与临床疗效。方法：回顾性分析2019年7月至2020年10月期间我院胸外科收治的42例前纵膈肿瘤患者的临床资料。其中男22例、女20例，年龄22～66(46.8±10.7)岁。所有患者采用经剑突肋缘下“三孔式”入路胸腔镜前纵膈肿瘤切除手术。结果：所有手术均成功，无中转开胸或延长手术切口长度患者。42例患者术后均恢复良好，未出现术后严重并发症及死亡病例，全组手术时间为(90±13.6)min，术中出血量为(29±10.9)mL，术后胸腔引流时间为(1.5±0.6)d，肿瘤最大直径(2.96±1.38)cm，住院时间为(8.6±1.2)d。结论：经剑突肋缘下“三孔式”入路能获得与正中开胸同样的手术视野，而且能彻底清除胸腺周围脂肪，具有安全、创伤小、术后疼痛轻、并发症少、恢复快的优点，适用于前纵膈肿瘤的切除，值得临床进一步推广应用。

Abstract

Objective:To investigate the safety and clinical efficacy of thoracoscopic treatment of anterior mediastinal tumors through the subcostal margin of xiphoid process with"three-hole"approach.
Methods:The clinical data of 42 patients with anterior mediastinal tumor admitted to the Department of Thoracic Surgery of our hospital from July 2019 to October 2020 were retrospectively analyzed.There were 22 males and 20 females,aged from 22 to 66(46.8±10.7) years.All patients underwent thoracoscopic resection of anterior mediastinal tumors through a"three-hole"approach under the xiphoid costal margin.
Results:All operations were successful.No patients were converted to thoracotomy or lengthening incision length.All the 42 patients recovered well after surgery,and no serious postoperative complications or death occurred.The operative time of the whole group was (90±13.6) min,the intraoperative blood loss was (29±10.9)mL,the postoperative thoracic drainage time was (1.5±0.6)d,the maximum tumor diameter was (2.96±1.38)cm,and the hospital stay was(8.6±1.2)d.
Conclusion  :The"three-hole"approach through the subcostal margin of xiphoid process can obtain the same surgical field of vision as the midline thoracotomy,and can completely remove the perithymus fat.It has the advantages of safety,less trauma,less postoperative pain,fewer complications and quick recovery.It is suitable for the resection of anterior mediastinal tumors and is worthy of further clinical promotion and application.