摘要目的: 研究经侧胸入路与经剑突下入路胸腔镜手术治疗纵隔肿瘤(MT)的应用效果。方法: 选取2020年6月~2023年6月我院收治118例MT患者,根据手术入路分为侧胸组(经侧胸入路胸腔镜手术,n=46)、剑突组(经剑突下入路胸腔镜手术,n=72),采用倾向性评分法进行1∶1匹配,两组各纳入患者43例。比较两组手术指标、术后疼痛、致痛因子水平、术后并发症发生率、术后1年复发率和生存情况。结果: 剑突组术后拔管时间、镇痛药使用天数均短于侧胸组,差异均有统计学意义(P<0.05);剑突组T1、T2、T3时间点数字评定量表(NRS)评分[(3.53±0.86)分、(2.46±0.65)分、(1.67±0.41)分]均低于侧胸组[(4.26±1.18)分、(3.73±0.92)分、(2.18±0.54)分],差异均有统计学意义(P<0.05);剑突组T1、T2、T3时间点血清缓激肽(BK)、神经肽Y(NPY)、前列腺素E2(PGE2)均低于侧胸组,差异均有统计学意义(P<0.05);剑突组并发症合计(6.99%)与侧胸组(13.98%)比较,差异无统计学意义(P>0.05);两组术后复发率(2.33% vs 2.33%)和病死率(0% vs 2.33%)比较,差异无统计学意义(P>0.05)。结论: 经剑突下入路胸腔镜手术治疗MT患者,能有效缩短患者的术后拔管时间和镇痛药使用时间,降低术后致痛因子水平,且治疗安全性较高。
Abstract：Objective: To study the efficacy of thoracoscopic surgery via lateral thoracic approach and subxiphoid approach in the treatment of mediastinal tumor (MT) and its influence on the levels of plasma pain-causing factors. Methods: Totally 118 patients with MT in the hospital from June 2020 to June 2023 were selected, and were divided into lateral thoracic group (thoracoscopic surgery via lateral thoracic approach, n=46) and xiphoid group (thoracoscopic surgery via subxiphoid approach, n=72) according to the surgical approaches. The propensity score method was used for 1∶1 matching, and 43 cases were included in each group. The surgical indicators, postoperative pain, pain-causing factors, incidence rates of postoperative complications, recurrence rate and survival status at 1 year after surgery were compared between groups. Results: The extubation time and analgesic days in xiphoid process group were shorter than those in lateral chest group, the differences were statistically significant (P<0.05). The scores of numerical rating scale (NRS) at T1, T2 and T3 in the xiphoid group with (3.53±0.86) points, (2.46±0.65) points and (1.67±0.41) points were lower than (4.26±1.18) points, (3.73±0.92) points and (2.18±0.54) points in the lateral thoracic group (P<0.05). Serum bradykinin (BK), neuropeptide Y (NPY) and prostaglandin E2 (PGE2) in the xiphoid group at T1, T2 and T3 were lower compared with those in the lateral thoracic group (P<0.05). There was no significant difference in total complications between xiphoid process group (6.99%) and lateral chest group (13.98%) (P>0.05). There was no significant difference in postoperative recurrence rate (2.33% vs 2.33%) and fatality rate (0% vs 2.33%) between the two groups (P>0.05). Conclusion: Thoracoscopic surgery via subxiphoid approach for patients with MT can effectively shorten the postoperative extubation time and analgesic use time, and reduce the levels of postoperative pain-causing factors, and it has high treatment safety.
孙建, 高从荣, 裴韶华. 经侧胸入路与经剑突下入路胸腔镜手术治疗纵隔肿瘤的应用效果研究[J]. 河北医学, 2025, 31(5): 811-815.
SUN Jian, GAO Congrong, PEI Shaohua. Study on the Efficacy of Thoracoscopic Surgery for Mediastinal Tumors by Lateral Thoracic Approach and Subxiphoid Approach. HeBei Med, 2025, 31(5): 811-815.
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2025, Vol. 31 
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