Clinical Comparative Study Of Thoracoscopic Subxiphoid Approach And Lateral Chest Approach For Thymectomy

Background and purpose:With the wide use of video-assisted thoracoscopic surgery(VATS),thoracoscopic thymectomy is becoming more and more popular.Even though thoracoscopic assisted surgery with the lateral chest approach has significant advantages over previous thoracotomy,the lateral thoracic incisions can not prevent the squeezing of intercostal nerves,which could cause pain in patients.The inability to clearly expose the anterior mediastinum is more evident when extensive anterior mediastinal fat removal is required.In theory,thoracoscopic subxiphoid approach for thymectomy can significantly reduce the pain caused by intercostal nerve injury,and better expose the bilateral pleura and the top of the anterior mediastinum.It is more beneficial for more extensive resection range of thymic tumors and anterior mediastinal fat.This study compared the clinical effects of thoracoscopic subxiphoid approach and lateral chest approach for thymectomy.We conducted the following research.Method:There were 104 patients who underwent thymectomy in General Hospital of First Affiliated Hospital of Soochow University from January 2017 to December 2018.The clinical comparative analysis of thoracoscopic subxiphoid approach and lateral chest approach for thymectomy was made in two groups.We conducted clinical comparison research of two groups of patients with the operation time,bleeding volume during operation,drain volume after operation,stopping drainage time,postoperative hospitalizative time,postoperative 1 day visual analogue scale,stopping drainage visual analogue scale,surgical complications,length and width of thymic neoplasm and anterior mediastinum fat.Result:The patients in both groups recovered smoothly and discharged safely after operation.There were no death cases after operation and no recurrence of tumors during follow-up.There was no significant difference between the two groups in operation time,bleeding volume during operation,drainage time after operation,postoperative hospitalizative time,drainage volume after operation and complications after operation(P>0.05).Scores of postoperative 1 day visual analogue scale and stopping drainage visual analogue scale in the subxiphoid approach group were smaller than that of the thoracoscopic lateral approach group(P<0.001).The length and width of thymectomy and anterior mediastinal fat specimen in the subxiphoid approach group were longer than those in the conventional lateral chest approach group.(P<0.05).Conclusion:Compared with thoracoscopic lateral chest approach,thoracoscopic subxiphoid approach for thymectomy has the advantages of less trauma,less pain,faster recovery,more extensive resection range of thymic tumors and anterior mediastinal fat,and no significant increase in surgical complications.Thoracoscopic subxiphoid approach for thymectomy is a more advanced and safer method of thymectomy under strict indication of operation.