A Clinical Comparative Study Of Thoracoscopic Subxiphoid Approach And Intercostal Approach In The Treatment Of Anterior Mediastinal Tumors

Objective: To compare the clinical efficacy and safety of thoracoscopic subxiphoid approach and intercostal approach in the treatment of mediastinal tumors.Methods: 65 patients with anterior mediastinal space occupying lesions were obtained from the Department of Thoracic surgery of the First Affiliated Hospital of Guangxi Medical University from January 2016 to November 2019.These patients were divided into subxiphoid VATS group(n = 33)and intercostal VATS group(n = 32)according to the surgical approach.The operation time,intraoperative blood loss,intraoperative chest tube indwelling rate,chest tube indwelling time,postoperative drainage,postoperative hospital stay time,postoperative complication rate,and postoperative pain score were compared between the two groups.The use of painkillers,recurrence rate and mortality of the two groups were followed up after discharge.Results: The intraoperative blood loss,intraoperative chest tube indwelling rate,chest tube indwelling time,postoperative drainage,postoperative hospital stay time and postoperative pain score in the subxiphoid process VATS group were significantly better than those in the intercostal approach VATS group(all P < 0.05),but there was no significant difference in operation time and postoperative complications between the two groups(all P>0.05).There was no perioperative death in all patients.Postoperative follow-up time ranged from 3to 48 months(mean 18.34 ±12.49 months),with a median time of 13.0 months.Four cases lost follow-up(two cases in subxiphoid VATS group and two cases in intercostal VATS group).In the intercostal VATS group,one patient diagnosed with thymoma relapsed and died of fungal infection caused by radiotherapy after recurrence during the follow-up period.There was no significant difference in the overall short-term recurrence rate and mortality between the two groups(all P>0.05).Conclusion: Thoracoscopic subxiphoid approach is an effective,minimally invasive,rapid recovery and high safety way in the treatment of anterior mediastinal tumors,which is worthy of application in clinical.