| Objective: To investigate the efficacy and safety of combined use of artificial pneumothorax and sternal traction hook for trans-subxiphoid thoracoscopic thymectomy,and to provide a basis for the further promotion and application of this improved operation.Methods:The clinical data of 60 patients who underwent subxiphoid thoracoscopic thymectomy in the Department of Thoracic surgery of the affiliated Hospital of Zunyi Medical University from January 2017 to January 2021 were analyzed retrospectively.Among them,26 patients received thoracoscopic thymectomy with artificial pneumothorax and sternal traction hook(combined group),18 patients with sternal traction retractor(hook group)and 16 patients with artificial pneumothorax assisted thoracoscopic thymectomy(pneumothorax group).The differences in operation time,intraoperative blood loss,postoperative analgesic use,postoperative drainage days,postoperative hospital stay and hospitalization costs between the two groups were compared.And to evaluate the feasibility,safety and efficacy of thoracoscopic thymoma resection through xiphoid process with artificial pneumothorax and sternal traction hook.Results:(1)The operative time The operative timeof the combined group(145.8±19.6)was significantly shorter than that of the hook group(163.3±28.9)and pneumothorax group(173.5±29.6),and the difference was statistically significant(P < 0.05)by ANOVA;(2)The intraoperative blood loss The intraoperative blood lossin the combined group,hook group,and pneumothorax group were 50.0(20.0,50.0)ml,50.0(30.0,50.0)m L,20.0(20.0,50.0)ml,respectively,and the difference was not statistically significant by rank sum test(P > 0.05);(3)Intraoperative complication The incidence rate of intraoperative hypotension(3.85%)、hypoxemia(7.69%)and hypercapnia(3.85%)in combined group were lower than that in pneumothorax group,and the differences were statistically significant(P < 0.05).There were no significant differences in the incidence of hypotension,hypoxemia and hypercapnia between the combined group and the hook group(P > 0.05);(4)Postoperative catheter time Postoperative catheter time in the combined group,hook group and pneumothorax group was 4.0(3.0,5.0)days,3.0(3.0,5.3)days,4.0(3.0,4.0)days,respectively,and the difference was not statistically significant by rank sum test(P > 0.05);(5)Postoperative pain The days of postoperative analgesic use in the combined group,hook group and pneumothorax group were 5.0(4.0,6.0)days,6.0(4.0,8.0)days,5.0(3.3,6.0),respectively,and the difference was not statistically significant(P > 0.05);(6)The postoperative hospitalization days The postoperative hospitalization days in combination group,hook group and pneumothorax group were(10.04 ±6.77)days,(9.67±6.15)days,(6.88 ±2.55)days,respectively;(7)Postoperative complications In the combined group,the incidence rate of pulmonary infection was 3.85% and the postoperative respiratory rate was 11.54%.After examination,there was no statistically significant difference in postoperative complications between the combined group,the pneumothorax group and the hook group;(8)The hospitalization cost The hospitalization cost of patients in the combined group,hook group,and pneumothorax group and combined group was(32237.77±7963.76)yuan,(32436.19±8814.93)yuan,(31089.96±6171.96)yuan,respectively,and the difference was not statistically significant after ANOVA(P > 0.05).Conclusion:Assisted thoracoscopic thymotomy combined with artificial pneumothorax and sternal traction hook has shorter operation time and lower incidence rate of intraoperative complications than assisted pneumothorax or sternal traction hook alone.At the same time,there was no significant difference in surgical outcome compared with the use of artificial pneumothorax or sternal traction hook thoracoscopic thymotomy alone,and there was no increase in hospitalization costs due to the use of the two auxiliary instruments. |
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