Clinical Application Of Tubeless Trans-subxiphoid Thoracoscopic Surgery In Anterior Mediastinal Tumor Resection

Objective:To discuss the safety,feasibility and advantages of tubeless trans-subxiphoid thoracoscopic surgery in anterior mediastinal tumor resection under the Guidance of Enhanced Recovery after Surgery.Method:A total of 32 patients suffering anterior mediastinal tumor enrolled,including 17 patients（8 males and 9 females）with average age of 31.8±8.4 years who have been performed tubeless trans-subxipohoid tharcoscopic surgery and 15 patients（8 males and 7 females）with average age of 31.1±9.2 years who have been performed traditional trans-subxipohoid tharcoscopic surgery.Patients in both groups were in supine position.Intramuscular injection of penehyclidine 0.6mg was performed 30minutes before anesthesia.Venous access was opened,continuously monitoring ECG,oxygen saturation,blood pressure,and respiratory rate.Tubeless group was performed intravenous anesthesia with laryngeal mask ventilation.Anesthesia was induced with0.5μg/kg sufentanil and 0.3mg/kg etomidate.A laryngeal mask was placed and oxygen flow was set at 2³ L/min.（5¹0 g/kg·h）remifentanil and（2⁴mg/kg·h）propofol were continuously pumped into the vein for anesthesia.Intraoperatively,5μg sufentanil was added at a time and 2mg cis-atracurium at a time.The control group was performed general anesthesia with endotracheal intubation.The anesthetic was induced with 0.5g/kg sufentanil,0.3mg/kg etomidate,0.15mg/kg atracurium cisphenesulfonate.A endotracheal intubation was placed and ventilation parameters were set as 7ml/kg,positive end-expiratory pressure（PEEP）5cmH₂O,respiratory rate 12 per minutes.5¹0μg/kg?h remifentanil,2⁴mg/kg·h propofol intravenous pumping and sevoflurane 1²%inhalation were used for anesthesia maintenance.Intraoperatively,5μg sufentanil was added at a time and 5mg cis-atracurium at a time.Patients in both groups underwent trans-subxiphoid thoracoscopic anterior mediastinal tumor resection.The differences of surgical duration,the lowest intraoperative arterial oxygen saturation（SaO2）,postoperative awaking time,postoperative pain visual analogue score（VAS）,postoperative pulmonary recruitment time,duration of postoperative hospital stay and hospitalization cost were analyzed.Statistical methods SPSS 24.0 software was used for statistical analysis.Measurement data were expressed by`x±s and comparison between groups was conducted by t-test.The n（%）-test was used for counting data and chi-square test was used for comparison between groups.P<0.05 was considered statistically significant.Results:Postoperative awaking time[（18.5±1.8）min vs.（28.9±4.2）min,P=0.000],postoperative pain visual analogue score（VAS）[（1.6±0.6）vs.（3.5±7.4）,P=0.000],duration of postoperative hospital stay[（2.5±7.2）d vs.（4.3±1.1）d,P=0.000]and hospitalization cost[（3.2±1.1）10kRMB vs.（4.9±1.1）10kRMB,P=0.000]in the tubeless group were better than them in the control group.There was no significant difference between the two in surgical duration[（51.7±6.5）min vs.（55.1±8.5）min],the lowest intraoperative arterial oxygen saturation（SaO2）[（98.5±0.9）%vs.（98.1±0.8）%],postoperative pulmonary recruitment time[（33.9±12.2）d vs.（38.4±15.2）d]（P>0.05）.Conclusion:Tubeless trans-subxiphoid thoracoscopic surgery is safe,feasible and advanced in anterior mediastinal tumor resection.