Clinical Analysis Of Subxiphoid Single-port Thoracoscopic Bilateral Pulmonary Bulla Resection

ObjectiveAs the thoracoscopic technology become more mature and thoracic surgery surgeon become more experienced, thoracic surgery has gone into the era of minimal invasion,the minimal pain and the maximal benefit for patients is the issue of Thoracic Surgeons. No matter thoracotomy or thoracoscopic surgery, intercostal incision, not only can easily lead to neuralgia, affecting postoperative recovery, but also lead to chronic pain after surgery, this clinical analysis is meant to study the effect of Subxiphoid single-port thoracoscopic pulmonary Bullae resection.MethodsWe had a retrospective analysis of Thoracic surgery of Shandong University Qilu Hospital and collected data from 36 patients who had subxiphoid thoracoscopic resection of bullae (hereafter subxiphoid group) in which 22 patients had Unilateral pulmonary bulla resection,14 patients had Bilateral pulmonary bulla resection from August,2014 to November, 2015,we also gathered data from 36 patients who had traditional "intercostal approach" thoracoscopic bullae resection (hereinafter referred to as "intercostal" group) in 2014 from January to July in Qilu hospital of thoracic Surgery as a control, Compare subxiphoid group and intercostal group in operative time, intraoperative Bleeding, postoperative total drainage, postoperative extubation time, postoperative hospital stay, incidence of postoperative complications and postoperative pain levels.ResultsTwo groups of patients had no 1 perioperative mortality, and all the patients kept stable and later got charged.In subxiphoid group and "intercostal" group with operative time, blood loss, post operative total drainage, postoperative extubation time, postoperative hospital stay, incidence of postoperative complications aspects there was no significant difference (P>0.05), the level of postoperative pain between the two groups was statistically significant difference (P<0.05).Subxiphoid group of patients only had mild chest and back pain, in addition to conventional intravenous analgesia pump, but no additional supplementary analgesia. Compared with "intercostal group" on pain levels, the difference between bilateral bullae resection was statistically significant (P<o.05), but the difference between unilateral bullae resection was not that obvious. Conclusion Unilateral bullae resection of subxiphoid approach has no obvious advantage, as bullae is more inclined to apex,operating distance is farther, the angle of using a linear cutter closure is more inconvenient than intercostal approach, is required higher operating skills, operating time is longer than the intercostal approach, incision length of surgery is consistent or longer, although there exist relief of post-operative pain, but statistically no special significance. Bilateral bullae resection of subxiphoid approach has no disadvantage in surgical time,but with operation becoming more skilled, the operating time is getting short, and even much shorter than the traditional intercostal approach, because xiphoid bullae resection do not have to turn over, do not have to re-cut approach edge, have less blood loss, compared with intercostal approach, bullae resection was significantly reduced in patients with postoperative pain.Bilateral subxiphoid thoracoscopic resection of lung bullae, as xiphoid have no bone structure around or intercostal nerve compression during surgery, postoperative pain is greatly reduced.There is only one subxiphoid incision,, compared with traditional thoracoscopic surgery,it is less invasive than the intercostal hole, have better postoperative recovery, patients benefit larger from surgery. However,as the surgical style is new and number of cases is small, reliability of statistics is limited, further research is needed to explore the pros and cons of subxiphoid approach compared with traditional intercostal style and possibilities of surgical biopsy of bilateral lung nodules.