Clinical analysis of thoracoscopic anterior mediastinal tumor resection in lithotomy position via subxiphoid approach or lateral position via transthoracic approach_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Renpeng , LI Yan , HU Wenteng , CAO Xiong , WANG Pengfei ,  HAN Biao

Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, P.R.China;

Corresponding author：

HAN Biao, Email: hanbiao66@163.com

Keywords：

Mediastinal mass; lithotomy position; lateral position; video-assisted thoracoscopic surgery

DOI：

10.7507/1007-4848.201903020

Video：

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Objective To discuss the safety, feasibility and short-term clinical efficacy of thoracoscopic anterior mediastinal mass resection in lithotomy position via subxiphoid approach or lateral position via transthoracic approach.Methods A total of 44 patients suffering anterior mediastinal tumor enrolled, including 21 patients (10 males and 11 females as a trial group) with an average age of 43.6±11.8 years who have been performed thoracoscopic anterior mediastinal tumor resection in lithotomy position via subxiphoid approach and 23 patients (13 males and 10 females as a control group) with an average age of 45.3±10.8 years who have been performed thoracoscopic anterior mediastinal tumor resection in lateral position via transthoracic approach. The clinical efficacy of the two groups was compared.Results Postoperative chest drainage time (3.8±1.3 d vs. 5.0±1.8 d, P=0.017), postoperative drainage volume (238.8±66.2 mL vs. 467.2±120.0 mL, P=0.000), postoperative mean visual analogue score at 24 h (2.5±0.9 point vs. 4.9±1.0 point, P=0.000), times of self-pressure analgesic pump (3.7±0.9 vs. 8.4±2.0, P=0.000), duration of postoperative hospital stay (4.7±1.3 d vs. 7.4±3.1 d, P=0.000) and hospitalization cost (34±8 kyaun vs. 44±11 kyuan P=0.001) in the trial group were all better than those in the control group. There was no significant difference between the two groups in surgical duration (59.0±18.1 min vs. 60.4±16.4 min) (P>0.05). During follow-up, no recurrence or metastasis occurred in either group.Conclusion Compared with the lateral position through the transthoracic approach, the lithotomy position through subxiphoid approach of thoracoscopic anterior mediastinal mass resection is safe and feasible, and has certain advantages.

Citation： LI Renpeng, LI Yan, HU Wenteng, CAO Xiong, WANG Pengfei, HAN Biao. Clinical analysis of thoracoscopic anterior mediastinal tumor resection in lithotomy position via subxiphoid approach or lateral position via transthoracic approach. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(12): 1171-1175. doi: 10.7507/1007-4848.201903020 Copy

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17.	Suda T, Sugimura H, Tochii D, et al. Single-port thymectomy through an infrasternal approach. Ann Thorac Surg, 2012, 93(1): 334-336.
18.	Suda T, Ashikari S, Tochii D, et al. Dual-port thymectomy using subxiphoid approach. Gen Thorac Cardiovasc Surg, 2014, 62(9): 570-572.
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21.	梁宝磊, 蔡庆勇, 梁贵友, 等. 剑突下单孔胸腔镜与双侧单孔胸腔镜同期处理双侧肺大疱的对比研究. 中国微创外科杂志, 2018, 18(10): 881-884.
22.	宋阳, 陈刚, 伍宁, 等. 电视胸腔镜与经胸骨胸腺切除治疗不伴胸腺瘤重症肌无力的临床分析. 中华胸部外科电子杂志, 2015, 2(3): 182-187.

1. 赵辉, 刘军, 李剑锋, 等. 纵隔镜手术在纵隔肿物诊断中的应用价值. 中国内镜杂志, 2006, 12(9): 925-927.
2. 柏启州, 于珺, 苟云久, 等. 达芬奇机器人手术疗纵隔肿瘤的病例对照研究. 中国胸心血管外科临床杂志, 2018, 25(5): 382-386.
3. 杨胜利, 茹婷巧, 杨劼, 等. 单操作孔全胸腔镜手术在纵隔肿物切除中的应用. 华中科技大学学报(医学版), 2015, 44(3): 330-333.
4. 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.
5. 叶凤清, 高春霞, 蒋桂莲, 等. 三种截石位摆放与复位方法的比较研究. 护理学杂志, 2014, 29(14): 36-38.
6. 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.
7. Zahid I, Sharif S, Routledge T, et al. Video-assisted thoracos-Copic surgery or transsternal thymectomy in the treatment of myas-thenia gravis? Interact Cardiovasc Thorac Surg, 2011, 12(1): 40-46.
8. Ng CS, Wan IY, Yim AP. Video-assisted thoracic surgery thymectomy: the better approach. Ann Thorac Surg, 2010, 89(6): S2135-S2141.
9. Kondo K. Therapy for thymic epithelial tumors. Gen Thorac Cardio-vasc Surg, 2014, 62: 468-474.
10. Kimura T, Inoue M, Kadota Y, et al. The oncological feasibility and limitations of video-assisted thoracoscopic thymectomy for early-stage thymomas. Eur J Cardiothorac Surg, 2013, 44(3): 214-218.
11. Ye B, Li W, Ge XX, et al. Surgical treatment of early-stage thymomas: Endosc robotassisted thoracoscopic surgery versus transster-nal thymectomy. Surg Endosc, 2014, 28(1): 122-126.
12. Numanami H, Yano M, Yamaji M, et al. Thoracoscopic thymectomy using a subxiphoid approach for anterior mediastinal tumors. Ann Thorac Cardiovasc Surg, 2018, 24: 65-72.
13. 于文滨. 腔镜甲状腺手术中 CO₂充气对大脑影响的实验研究. 山东大学, 2009.
14. 唐渲, 梁毅. 经剑突下单孔胸腔镜手术的临床应用. 广东医学, 2016, 37(S1): 131-132.
15. Gothard J. Lung injury after thoracic surgery and one-lung ventilation. Curr Opin Anaesthesiol, 2006, 19(1): 5-10.
16. 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.
17. Suda T, Sugimura H, Tochii D, et al. Single-port thymectomy through an infrasternal approach. Ann Thorac Surg, 2012, 93(1): 334-336.
18. Suda T, Ashikari S, Tochii D, et al. Dual-port thymectomy using subxiphoid approach. Gen Thorac Cardiovasc Surg, 2014, 62(9): 570-572.
19. Suda T. Single-port thymectomy using a subxiphoid approach: surgical techni-que. Ann Cardiothorac Surg, 2016, 5(1): 56-58.
20. Gonzalez-Rivas D. Recent advances in uniportal video-assisted thoracoscopic surgery. Chin J Cancer Res, 2015, 27(1): 90-93.
21. 梁宝磊, 蔡庆勇, 梁贵友, 等. 剑突下单孔胸腔镜与双侧单孔胸腔镜同期处理双侧肺大疱的对比研究. 中国微创外科杂志, 2018, 18(10): 881-884.
22. 宋阳, 陈刚, 伍宁, 等. 电视胸腔镜与经胸骨胸腺切除治疗不伴胸腺瘤重症肌无力的临床分析. 中华胸部外科电子杂志, 2015, 2(3): 182-187.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical analysis of thoracoscopic anterior mediastinal tumor resection in lithotomy position via subxiphoid approach or lateral position via transthoracic approach

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