使用单孔和三孔胸腔镜胸腺切除术治疗无创上皮性胸腺肿瘤的即时效果比较分析

E. A. Epifantsev, A. V. Smirnov, V. Gritsun, A. Keshvedinova, Yu. V. Ivanov
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引用次数: 0

摘要

研究目的评估单孔胸腔镜胸腺切除术与传统三孔胸腺切除术在I期和II期胸腺上皮肿瘤患者中的安全性和有效性。分析了2019年1月至2023年5月期间为无肌无力的I期和II期胸腺上皮肿瘤患者实施的50例胸腔镜胸腺切除术的结果。患者年龄从20岁到75岁不等,中位数为44岁。其中女性 28 人(56%),男性 22 人(44%)。研究中切除的胸腺瘤最小为 20 毫米,最大为 165 毫米。在接受单孔和三孔胸腔镜胸腺切除术的50名患者中,42人(84%)的肿瘤直径在70毫米以下,8人(16%)的肿瘤直径大于70毫米。三孔胸腺切除术组的肿瘤尺寸明显更大(43 mm [35 mm; 55 mm] vs. 60 mm [38 mm; 78 mm], p = 0.044)。分析结果表明,三孔胸腔镜胸腺切除术组的手术时间明显延长(手术时间为 107.5 分钟 [70 分钟;132.5 分钟] 与单孔胸腔镜胸腺切除术组的 70.0 分钟 [57 分钟;79 分钟] 相比)。在胸腔引流和术后卧床时间方面,结果也有统计学意义。采用单孔入路手术的患者平均住院时间为 3 至 5 天(4.0 天),而采用三孔入路手术的患者平均住院时间为 3 至 13 天(5.0 天)。对比分析表明,单孔胸腔镜胸腺切除术与三孔手术相比,住院时间明显缩短。这项研究是俄罗斯第一项比较单孔和三孔胸腺肿瘤切除技术的研究,患者人数足以进行统计计算。研究表明,对于5厘米以下的胸腺肿瘤,单孔胸腔镜胸腺切除术与三孔胸腔镜胸腺切除术相比,不会导致手术时间延长或术中术后并发症增加。因此,我们认为单孔胸腔镜胸腺切除术是更可取的选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparative analysis of the immediate results of thoracoscopic thymectomy using single-port and three-port approaches in the treatment of non-invasive epithelial thymic tumors
Purpose of the study. Evaluation of the safety and effectiveness of single-port thoracoscopic thymectomy in comparison with traditional three-port thymectomy in patients with stage I and II thymic epithelial tumors.Patients and methods. The results of 50 thoracoscopic thymectomies performed from January 2019 to May 2023 on patients with stage I and II thymic epithelial tumors without the presence of myasthenia were analyzed. The age of the patients ranged from 20 to 75 years, with a median of 44 years. There were 28 (56 %) women, 22 (44 %) men. The minimum size of the removed thymoma in the study was 20 mm, the maximum was 165 mm. Out of the 50 patients who underwent singleand three-port thoracoscopic thymectomy, 42 (84 %) had tumor diameters of 70 mm or less, and 8 (16 %) had tumor diameters greater than 70 mm. Tumor size was significantly larger in the three-port thymectomy group (43 mm [35 mm; 55 mm] vs. 60 mm [38 mm; 78 mm], p = 0.044).Results. The analysis noted a statistically significant increase in the duration of the operation in the group of three-port thoracoscopic thymectomies (duration of operations – 107.5 minutes [70 minutes; 132.5 minutes] versus 70.0 minutes [57 minutes; 79 minutes] in the group with a single-port approach). A statically significant result was also obtained in terms of drainage of pleural cavity drainage and, as a consequence, in duration of postoperative bed rest. Patients operated through a single-port approach stayed in the hospital for 3 to 5 days on average (4.0 days), while those with a three-port approach stayed from 3 to 13 days on average (5.0 days). A comparative analysis revealed a significant reduction in the length of hospital stay in patients who underwent single-port thoracoscopic thymectomy, in contrast to those undergoing three-port surgical interventions.Conclusion. This study is the first in Russia to compare oneand three-port techniques for removing thymic tumors in a number of patients sufficient for statistical calculations. It has been shown that for thymic tumors up to 5 cm, single-port thoracoscopic thymectomy compared to three-port does not lead to prolongation of the operation or an increase in intraand postoperative complications. Therefore, in our opinion, it is the preferable option.
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