Analysis Of Influencing Factors Of Operation Time Of Subxiphoid Video-assisted Thoracoscopic Extended Thymectomy

Objective:To explore the independent risk factors of operation time of video-assisted thoracoscopic extended thymectomy for clinical guidance.Methods:The clinical data of 51 cases of subxiphoid video-assisted thoracoscopic extended thymectomy in the Second People’s Hospital of Yunnan Province from January 2018 to April 2021 were collected as the research objects,according to whether the operation time was longer than 107 minutes,the patients were divided into the prolonged operation time group and the non-prolonged operation time group.Univariate analysis was used for gender,age,BMI,pathological classification,size of the substernal angle,ratio of anterior and posterior thoracic diameter to left and right thoracic diameter,the straight line distance from 1cm below the intersection of the right midclavicular line and the costal arch(operation point under the costal margin)to the jugular notch(c-a-D)and the vertical distance from the sternum to the leading edge of the aorta on the carina level of chest CT(s-a-d),and multivariate Logistic regression analysis was used to analyze the independent risk factors affecting the operation time for the above-mentioned statistically significant indicators.Results:Univariate analysis showed that there was no statistical significance in gender,age,BMI,intraoperative blood loss and ratio of anterior and posterior thoracic diameter to left and right thoracic diameter(P>0.05).There were statistically significant differences in pathological types,size of the substernal angle,s-a-d and c-a-D(P<0.05).Univariate analysis results were as follows:The size of the substernal Angle:prolonged operation time group(68.32±2.50)°,non-prolonged operation time group(70.03±3.02)°,the difference between the two groups was statistically significant(P<0.05);s-a-d:prolonged operation time group(19.77±5.17)cm,non-prolonged operation time group(25.70±5.54)cm,the difference between the two groups was statistically significant(P<0.05);c-a-D:prolonged operation time group(31.15±2.88)cm,non-prolonged operation time group(28.67±2.09)cm,the difference between the two groups was statistically significant(P<0.05);pathological types:thymic hyperplasia(10 cases)and thymoma(12 cases)were found in the extended operation time group,while thymic hyperplasia(23 cases)and thymoma(6 cases)were found in the non-extended operation time group,and the difference between the two groups was statistically significant(P<0.05).The results of multivariate Logistic analysis showed that pathological type[OR=6.78,95%CI=(1.18,39.14),P=0.032],s-a-d[OR=0.81,95%CI=(0.70,0.95),P=0.007],c-a-D[OR=1.65,95%CI=(1.14,2.38),P=0.008]were independent factors affecting the operation time.Conclusion:pathological type,the straight line distance from the intersection of the right midclavicular line and the costal arch(operation point under the costal margin)to the jugular notch(c-a-D)and the vertical distance from the sternum to the leading edge of the aorta on the carina level of chest CT(s-a-d)were independent factors affecting the operative time of subxiphoid video-assisted thoracoscopic extended thymectomy.