A clinical analysis on subxiphoid and intercostal video-assisted thoracoscopic extended thymectomy

doi:10.3877/cma.j.issn.1674-6899.2019.03.009

Abstract

Abstract:

Objective

To explore the clinical characteristics of video-assisted thoracoscopic (VATS) extended thymectomy via subxiphoid and intercostal approaches.

Methods

Clinical data of consecutive VATS extended thymectomy performed between Jan. 2015 and Dec. 2018 in Department of Thoracic Surgery of Xuzhou Central Hospital was retrospectively analyzed. The patients were divided into intercostal multiple VATS (MVATS) group, subxiphoid MVATS group and subxiphoid uniportal VATS (UVATS) group. The operation-related parameters were compared respectively among the groups.

Results

There were 5 cases in the intercostal group and 7 cases in the subxiphoid groups suffered from myasthenia gravies (MG) before surgery. There was no short-term mortality, or conversion to thoracotomy. Three patients in subxiphoid UVATS group converted to subxiphoid MVATS. Besides, as compared with the subxiphoid MVATS and UVATS group, the patients of intercostal MVATS group revealed shorter operation time [(64.0±15.1) min vs (71.4±18.1) min vs (87.4±18.7) min, P< 0.05], shorter chest tube drainage [(1.5±0.7) d vs (2.3±1.1) d vs (2.9±1.3) d, P< 0.05], smaller drainage volume [(131.4±66.5) ml vs (169.9±110.6) ml vs (231.5±111.9) ml, P<0.05], shorter postoperative stay [(1.9±1.1) d vs (3.1±2.0) d vs (3.7±2.8) d, P< 0.05], but higher pain score on the first postoperative day [(4.2±1.3) vs (3.7±1.1) vs (3.5±1.2), P<0.05]. In addition, subxiphoid UVATS group reported two cases of MG crisis after surgery. Besides, incomplete resection of anterior mediastinal fat tissue was found in 1 case in the subxiphoid MVATS group and 5 cases in the UVATS group, as shown by computered tomography after surgery.

Conclusions

Subxiphoid VATS extended thymectomy is feasible, but it does not indicate significant advantages as compared with intercostal MVATS approach.

Key words: Subxiphoid, Uniportal, Video-assisted thoracic surgery, Thymectomy

Miao Zhang, Wenbin Wu, Dunpeng Yang, Dong Liu, Hui Zhang, Zhengqun Hu. A clinical analysis on subxiphoid and intercostal video-assisted thoracoscopic extended thymectomy[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2019, 12(03): 166-170.

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URL: https://zhqjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6899.2019.03.009

https://zhqjwkzz.cma-cmc.com.cn/EN/Y2019/V12/I03/166

Figures/Tables 2

References 19

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组别	例数	性别(例)		年龄(岁， ±s)	体质量指数(kg/m², ±s)	肿瘤直径(cm, ±s)	合并MG (例)	术前血浆置换并MG (例)
组别	例数	男	女	年龄(岁， ±s)	体质量指数(kg/m², ±s)	肿瘤直径(cm, ±s)	合并MG (例)	术前血浆置换并MG (例)
肋间MVATS组	46	17	29	49.5±17.1	24.8±3.1	5.0±1.6	5	3
剑突下MVATS组	40	21	19	50.0±17.1	24.3±2.8	5.2±1.7	3	1
剑突下UVATS组	27	15	12	50.4±10.6	24.0±3.0	4.5±1.8	4	1
统计值	?	3.142		0.063	0.714	1.251	－	－
P值	?	0.208		0.939	0.492	0.290	－	－

组别	例数	性别(例)		年龄(岁， ±s)	体质量指数(kg/m², ±s)	肿瘤直径(cm, ±s)	合并MG (例)	术前血浆置换并MG (例)
组别	例数	男	女	年龄(岁， ±s)	体质量指数(kg/m², ±s)	肿瘤直径(cm, ±s)	合并MG (例)	术前血浆置换并MG (例)
肋间MVATS组	46	17	29	49.5±17.1	24.8±3.1	5.0±1.6	5	3
剑突下MVATS组	40	21	19	50.0±17.1	24.3±2.8	5.2±1.7	3	1
剑突下UVATS组	27	15	12	50.4±10.6	24.0±3.0	4.5±1.8	4	1
统计值	?	3.142		0.063	0.714	1.251	－	－
P值	?	0.208		0.939	0.492	0.290	－	－

组别	例数	手术时间(min, ±s)	术中出血量(ml, ±s)	术后胸腔引流( ±s)		术后并发症(例)
组别	例数	手术时间(min, ±s)	术中出血量(ml, ±s)	引流时间(d)	引流量(ml)	肺部感染	肺漏气>7d	心律失常
肋间MVATS组	46	64.0±15.1	25.1±10.6	1.5±0.7	131.4±66.5	1	0	2
剑突下MVATS组	40	71.4±18.1^a	27.6±10.6	2.3±1.1^a	169.9±110.6	2	1	6
剑突下UVATS组	27	87.4±18.7^ab	28.5±14.1	2.9±1.3^ab	231.5±111.9^ab	1	0	5
统计值	?	15.993	0.898	17.183	9.354	5.490
P值	?	< 0.001	0.410	< 0.001	< 0.001	0.068
组别	例数	术后MG危象(例)		术后血浆置换(例)	术后住院时间(d， ±s)	视觉模拟评分(分， ±s)		CT示脂肪影残留(例)
组别	例数	术前有MG	术前无MG	术后血浆置换(例)	术后住院时间(d， ±s)	术后1 d	术后3 d	CT示脂肪影残留(例)
肋间MVATS组	46	0	0	0	1.9±1.1	4.2±1.3	3.2±1.1	0
剑突下MVATS组	40	0	0	0	3.1±2.0^a	3.7±1.1^a	3.0±1.3	1
剑突下UVATS组	27	1	1	2	3.7±2.8^a	3.5±1.2^a	1.2±0.2	5
统计值	?	－	－	－	8.649	4.110	1.835	－
P值	?	－	－	－	< 0.001	0.019	0.164	－

组别	例数	手术时间(min, ±s)	术中出血量(ml, ±s)	术后胸腔引流( ±s)		术后并发症(例)
组别	例数	手术时间(min, ±s)	术中出血量(ml, ±s)	引流时间(d)	引流量(ml)	肺部感染	肺漏气>7d	心律失常
肋间MVATS组	46	64.0±15.1	25.1±10.6	1.5±0.7	131.4±66.5	1	0	2
剑突下MVATS组	40	71.4±18.1^a	27.6±10.6	2.3±1.1^a	169.9±110.6	2	1	6
剑突下UVATS组	27	87.4±18.7^ab	28.5±14.1	2.9±1.3^ab	231.5±111.9^ab	1	0	5
统计值	?	15.993	0.898	17.183	9.354	5.490
P值	?	< 0.001	0.410	< 0.001	< 0.001	0.068
组别	例数	术后MG危象(例)		术后血浆置换(例)	术后住院时间(d， ±s)	视觉模拟评分(分， ±s)		CT示脂肪影残留(例)
组别	例数	术前有MG	术前无MG	术后血浆置换(例)	术后住院时间(d， ±s)	术后1 d	术后3 d	CT示脂肪影残留(例)
肋间MVATS组	46	0	0	0	1.9±1.1	4.2±1.3	3.2±1.1	0
剑突下MVATS组	40	0	0	0	3.1±2.0^a	3.7±1.1^a	3.0±1.3	1
剑突下UVATS组	27	1	1	2	3.7±2.8^a	3.5±1.2^a	1.2±0.2	5
统计值	?	－	－	－	8.649	4.110	1.835	－
P值	?	－	－	－	< 0.001	0.019	0.164	－

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