Comparison Of Sternum Suspension And Subxiphoid Thoracoscopy For The Treatment Of Thymoma And Thoracic Approach Surgery

Objective:Thymoma is one of the common anterior mediastinal tumors,and the main treatment is surgical resection.This study compared the perioperative indexes of minimally invasive thoracic approach and subxiphoid approach for resection of thymoma to provide a basis for the selection of surgical methods before surgery.Methods:A retrospective analysis was performed for a total of 81 patients with thymoma or thymic cancer in stage I.-II.of Masaoka who underwent minimally invasive surgery from January 2020 to December 2022.According to the surgical method,it was divided into subxiphoid approach group and thoracic approach group,and perioperative data were collected,including operation time,postoperative hospital stay,postoperative tube delivery days,pain score,postoperative drainage,postoperative analgesic drug use,lesion size,whether the lesion was complete,etc.The perioperative data of the two surgical modalities were compared,and a multivariate logistic regression analysis was performed on the risk factors for additional perioperative analgesic drugs in patients after surgery.Results:There were no significant differences between the thoracic approach group and the subxiphoid approach group in terms of operation time(72.94±30.1 min VS83.96±25.66 min,t=1.76,p=0.08),postoperative tube with tube(3.70±1.68 days vs3.06±1.32 days,t=-1.96,p=0.06),postoperative hospital days(3.5(3.0,4.0)days VS4.0(3.0,5.0)days,W=636.5,p=0.07),Chest tube drainage(562.5(312.5,805.0)ml VS460.0(255.0,737.5)ml,W=657,p=0.30),The pathological longest path subxiphoid approach group was larger than the thoracic approach group(7.8±2.43 VS 4.95±2.78,t=4.04,p≤0.00),There was no significant difference in specimen integrity(complete resection of the upper and left and right grades of thymus)between the two groups(P=0.24),and the postoperative analgesic medication time was shorter in the subxiphoid approach group(2.67±1.10 days vs 3.33±1.41 days,t=-2.39,p=0.01),and the dose of analgesic drugs was less(28.33±11.55mg vs 38.69±20.36mg,t=-2.64,p=0.01),According to the results of multivariate logistic regression,the subxiphoid approach was a protective factor for additional use of analgesic drugs after surgery(OR value was 0.28,Waldχ~2=3.45,p=0.048,95%CI was(0.07,0.97)),and smoking history,diabetes history and increased BMI were risk factors for additional use of analgesic drugs after surgery.Conclusion:The subxiphoid approach group has more advantages in exposing thymoma during intraoperative dissection,and has a larger range of resection than the thoracic approach group,and the subxiphoid approach surgery group has a greater advantage than the thoracic approach group in postoperative pain management,and the subxiphoid approach can effectively reduce the damage to the intercostal nerve and protect patients with postoperative chest pain.