探讨经剑突肋缘下入路胸腔镜前纵隔肿瘤手术的安全性和有效性。

回顾性分析解放军总医院第一医学中心胸外科2017年7月至2021年5月收治的54例前纵隔肿瘤切除患者(经剑突下组)的临床资料，选取同期在解放军总医院第一医学中心行经肋间入路的前纵隔肿物切除患者54例作为对照组(经肋间组)。对比两组的手术时间、术中出血量、术后带管时间、术后引流量、术后2 d和术后3个月疼痛视觉模拟评分(visual analogue scale，VAS)、术后并发症的差异。

经剑突下组与经肋间组在术中出血量、术后带管时间及术后引流量方面，差异无统计学意义(P>0.05)；但在手术时间、术后2 d疼痛分数方面，差异有统计学意义(P<0.05)；经剑突下后期组与经肋间后期组对比分析，两组在术后带管时间、术后引流量、术后2 d VAS方面，差异有统计学意义(P<0.05)；而手术时间、术中出血量方面，差异无统计学意义(P>0.05)；两组间术后3个月VAS分数，差异有统计学意义(P<0.05)。

经剑突肋缘下胸腔镜手术治疗前纵隔肿瘤术中有更良好的手术视野和手术安全性，术后疼痛明显减轻；度过20余例学习曲线后，术后带管时间及引流量明显减少，在加速康复方面较经肋间组有明显优势。

To explore the safety and availability of video-assisted thoracic surgery for anterior mediastinal tumors via subxiphoid.

A retrospective analysis was performed with anterior mediastinal tumors undertaken VATS resection via subxiphoid or lateral intercostal approaches from Jul. 2017 to May 2021 in the PLA General Hospital. Each group included 54 patients. The clinical characteristics and early surgical outcomes of these patients were reviewed and analyzed.

Patients in the subxiphoid approach group had more myasthenia gravis (MG) than that in the intercostal group. There was no significant difference in the maximal tumor diameter between two groups. One patient of 54 patients in the subxiphoid approach group was switched to sternotomy due to the serious invading left innominate vein of a thymic carcinoma. Compared with the lateral intercostal approach, the duration of the procedure via the subxiphoid approach was significantly longer (P<0.05), the pain scores on postoperative days 2 was significantly lower (P<0.05). There was no significant difference in the intraoperative blood loss, duration of chest drainage and postoperative drainage volume between two groups. However, in the later stage subgroup of the subxiphoid approach, duration of chest drainage, postoperative drainage volume and postoperative pain were significantly lower than those in lateral intercostal approach. There was no significant difference in the operative duration and the intraoperative blood loss between the later stage subgroup of the subxiphoid approach and contemporary lateral intercostal approach group. Patients in subxiphoid approach group had lower postoperative pain than those in lateral intercoastal group on postoperative 3 months(P<0.05).

Video-assisted thoracic surgery for anterior mediastinal tumors via subxiphoid had a good surgical field of vision and safety. After getting through the learning curve of about 20 cases, the subxiphoid approach has faster recovery after surgery with advantages of shorter duration of chest drainage, less postoperative drainage volume and better quality of life compared with the lateral intercoastal approach.