Clinical application of tubeless trans-subxiphoid thoracoscopic surgery in anterior mediastinal tumor resection: A case control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YUE Hanxun ¹ , ZHANG Yu ¹ , MA Minjie ¹ , WEI Ning ¹ , HUO Bin ² , LIN Ruijiang ¹ ,  HAN Biao ¹

1. Department of Thoracic Surgery, Lanzhou University First Hospital, Lanzhou, 730000, P.R.China;
2. Department of Anesthesiology, Lanzhou University First Hospital, Lanzhou, 730000, P.R.China;

Corresponding?author：

HAN Biao, Email: hanbiao66@163.com

Keywords：

Spontaneous breathing anesthesia; enhanced recovery after surgery; thoracoscopy; mediastinal tumor

DOI：

10.7507/1007-4848.201808001

Video：

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Objective To discuss the safety, feasibility and advantages of tubeless trans-subxiphoid thoracoscopic surgery in anterior mediastinal tumor resection. Methods A total of 32 patients suffering anterior mediastinal tumor were enrolled, including 17 patients (8 males and 9 females) with average age of 31.8±8.4 years who had been performed tubeless trans-subxipohoid tharcoscopic surgery and 15 patients (8 males and 7 females) with average age of 31.1±9.2 years who had been performed traditional trans-subxipohoid tharcoscopic surgery. The differences of surgical duration, the lowest intraoperative arterial oxygen saturation (SaO₂), postoperative awaking time, postoperative pain visual analogue score (VAS), postoperative pulmonary recruitment time, duration of postoperative hospital stay and hospitalization cost were analyzed. Results Postoperative awaking time (18.5±1.8 min vs. 28.9±4.2 min, P=0.000), postoperative VAS (1.6±0.6 vs. 3.5±7.4, P=0.000), duration of postoperative hospital stay (2.5±7.2 d vs. 4.3±1.1 d, P=0.000) and hospitalization cost (3.2±1.1 ten thousand RMB vs. 4.9±1.1 10 ten thousand RMB, P=0.000) in the tubeless group were better than those in the control group. There was no significant difference in surgical duration (51.7±6.5 min vs. 55.1±8.5 min), the lowest intraoperative SaO₂ (98.5%±0.9% vs. 98.1%±0.8%), postoperative pulmonary recruitment time (33.9±12.2 d vs. 38.4±15.2 d, P>0.05) between the two groups.Conclusion Tubeless trans-subxiphoid thoracoscopic surgery is safe, feasible and advanced in anterior mediastinal tumor resection.

Citation： YUE Hanxun, ZHANG Yu, MA Minjie, WEI Ning, HUO Bin, LIN Ruijiang, HAN Biao. Clinical application of tubeless trans-subxiphoid thoracoscopic surgery in anterior mediastinal tumor resection: A case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(4): 353-357. doi: 10.7507/1007-4848.201808001 Copy

1.	彭凱明, 康明強, 林濟紅, 等. 經劍突下胸腔鏡手術治療前縱隔腫瘤療效分析. 中華胸部外科電子雜志, 2018, 5(1): 16-21.
2.	孟慶軍, 孔繁義, 宋翔. 經劍突下及肋弓下切口胸腔鏡胸腺切除術的臨床分析. 中國胸心血管外科臨床雜志, 2018, 25(5): 449-452.
3.	程少先, 徐文禮, 艾瑞華, 等. 胸腔鏡劍突下小切口治療雙側胸腺瘤的臨床效果. 中國當代醫藥, 2018, 25(13): 8-12.
4.	張進, 楊鯤鵬, 王旭廣, 等. 胸腺切除術后不放置胸腔及縱隔引流可行性的研究. 中國現代手術學雜志, 2012, 16(2): 112-114.
5.	陳舒晨, 余紹斌, 林濟紅, 等. 經劍突下入路胸腔鏡下前縱隔腫瘤切除術學習曲線分析. 福建醫科大學學報, 2017, 51(5): 311-315.
6.	Xia Z, Qiao K, He J. Recent advances in the management of pulmonary tuberculoma with focus on the use of tubeless video-assisted thoracoscopic surgery. J Thorac Dis, 2017, 9(9): 3307-3312.
7.	Cui F, Liu J, Li S, et al. Tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of chest tube postoperatively. J Thorac Dis, 2016, 8(8): 2226-2232.
8.	鐘斌, 吳奇勇, 童繼春, 等. 劍突下入路胸腔鏡下前縱隔腫瘤摘除術 16 例報告. 實用臨床醫藥雜志, 2017, 21(19): 119-120.
9.	張勇, 王哲, 張廣健, 等. 經劍突下胸腔鏡技術在前縱隔腫瘤外科治療中的應用. 現代腫瘤醫學, 2017, 25(11): 1731-1733.
10.	方澤民, 王躍斌, 丁志丹, 等. 劍突下單孔胸腔鏡手術在前縱隔腫瘤治療中的應用. 河南醫學研究, 2018, 27(5): 890-891.
11.	張科, 童繼春, 吳奇勇. 經劍突下胸腔鏡技術在胸腺瘤切除術中的應用. 中國微創外科雜志, 2018, 18(2): 107-109.
12.	Gothard J. Lung injury after thoracic surgery and one-lung ventilation. Curr Opin Anaesthesiol, 2006, 19(1): 5-10.
13.	周一凡, 鐘永瀧, 林輝, 等. 經劍突入路胸腔鏡胸腺擴大切除治療重癥肌無力的臨床分析. 中國胸心血管外科臨床雜志, 2017, 24(4): 318-320.
14.	Blanchet MC, Frering V, Gignoux B, et al. Four-Year Evolution of a thrombophylaxis protocol in an enhanced recovery after surgery (ERAS) program: Recent results in 485 patients. Obes Surg, 2018. doi: 10.1007/s11695-018-3299-4.[Epub ahead of print].
15.	蔡開燦, 王向東, 葉靖, 等. 喉罩全麻與氣管插管全麻胸腔鏡手術治療肺大皰的臨床對照研究. 南方醫科大學學報, 2013, 33(5): 756-760.
16.	Boisen ML, Rao VK, Kolarczyk L, et al. The Year in Thoracic Anesthesia: Selected Highlights from 2016. J Cardiothorac Vasc Anesth, 2017, 31(3): 791-799.
17.	Feneley RC, Hopley IB, Wells PN. Urinary catheters: history, current status, adverse events and research agenda. J Med Eng Technol, 2015, 39(8): 459-470.
18.	張滿, 靳智勇, 馬英, 等. 自主呼吸麻醉結合單孔非置管胸腔鏡技術在肺大皰切除術中應用的隨機對照試驗. 中國胸心血管外科臨床雜志, 2018, 25(3): 218-221.
19.	Peng G, Liu M, Luo Q, et al. Spontaneous ventilation anesthesia combined with uniportal and tubeless thoracoscopic lung biopsy in selected patients with interstitial lung diseases. J Thorac Dis, 2017, 9(11): 4494-4501.
20.	Li S, Jiang L, Ang KL, et al. New tubeless video-assisted thoracoscopic surgery for small pulmonary nodules. Eur J Cardiothorac Surg, 2017, 51(4): 689-693.
21.	Gonzalez-Rivas D, Yang Y, Guido W, et al. Non-intubated (tubeless) uniportal video-assisted thoracoscopic lobectomy. Ann Cardiothorac Surg, 2016, 5(2): 151-153.
22.	Gonzalez-Rivas D, Bonome C, Fieira E, et al. Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery? Eur J Cardiothorac Surg, 2016, 49(3): 721-731.
23.	Watanabe A, Watanabe T, Ohsawa H, et al. Avoiding chest tube placement after video-assisted thoracoscopic wedge resection of the lung. Eur J Cardiothorac Surg, 2004, 25(5): 872-876.
24.	Holbek BL, Hansen HJ, Kehlet H, et al. Thoracoscopic pulmonary wedge resection without post-operative chest drain: an observational study. Gen Thorac Cardiovasc Surg, 2016, 64(10): 612-617.
25.	袁江, 張永學, 高兆明. 劍突下單孔胸腔鏡與三孔胸腔鏡前縱隔腫瘤切除的臨床療效對比. 中國老年學雜志, 2017, 37(15): 3815-3817.

1. 彭凱明, 康明強, 林濟紅, 等. 經劍突下胸腔鏡手術治療前縱隔腫瘤療效分析. 中華胸部外科電子雜志, 2018, 5(1): 16-21.
2. 孟慶軍, 孔繁義, 宋翔. 經劍突下及肋弓下切口胸腔鏡胸腺切除術的臨床分析. 中國胸心血管外科臨床雜志, 2018, 25(5): 449-452.
3. 程少先, 徐文禮, 艾瑞華, 等. 胸腔鏡劍突下小切口治療雙側胸腺瘤的臨床效果. 中國當代醫藥, 2018, 25(13): 8-12.
4. 張進, 楊鯤鵬, 王旭廣, 等. 胸腺切除術后不放置胸腔及縱隔引流可行性的研究. 中國現代手術學雜志, 2012, 16(2): 112-114.
5. 陳舒晨, 余紹斌, 林濟紅, 等. 經劍突下入路胸腔鏡下前縱隔腫瘤切除術學習曲線分析. 福建醫科大學學報, 2017, 51(5): 311-315.
6. Xia Z, Qiao K, He J. Recent advances in the management of pulmonary tuberculoma with focus on the use of tubeless video-assisted thoracoscopic surgery. J Thorac Dis, 2017, 9(9): 3307-3312.
7. Cui F, Liu J, Li S, et al. Tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of chest tube postoperatively. J Thorac Dis, 2016, 8(8): 2226-2232.
8. 鐘斌, 吳奇勇, 童繼春, 等. 劍突下入路胸腔鏡下前縱隔腫瘤摘除術 16 例報告. 實用臨床醫藥雜志, 2017, 21(19): 119-120.
9. 張勇, 王哲, 張廣健, 等. 經劍突下胸腔鏡技術在前縱隔腫瘤外科治療中的應用. 現代腫瘤醫學, 2017, 25(11): 1731-1733.
10. 方澤民, 王躍斌, 丁志丹, 等. 劍突下單孔胸腔鏡手術在前縱隔腫瘤治療中的應用. 河南醫學研究, 2018, 27(5): 890-891.
11. 張科, 童繼春, 吳奇勇. 經劍突下胸腔鏡技術在胸腺瘤切除術中的應用. 中國微創外科雜志, 2018, 18(2): 107-109.
12. Gothard J. Lung injury after thoracic surgery and one-lung ventilation. Curr Opin Anaesthesiol, 2006, 19(1): 5-10.
13. 周一凡, 鐘永瀧, 林輝, 等. 經劍突入路胸腔鏡胸腺擴大切除治療重癥肌無力的臨床分析. 中國胸心血管外科臨床雜志, 2017, 24(4): 318-320.
14. Blanchet MC, Frering V, Gignoux B, et al. Four-Year Evolution of a thrombophylaxis protocol in an enhanced recovery after surgery (ERAS) program: Recent results in 485 patients. Obes Surg, 2018. doi: 10.1007/s11695-018-3299-4.[Epub ahead of print].
15. 蔡開燦, 王向東, 葉靖, 等. 喉罩全麻與氣管插管全麻胸腔鏡手術治療肺大皰的臨床對照研究. 南方醫科大學學報, 2013, 33(5): 756-760.
16. Boisen ML, Rao VK, Kolarczyk L, et al. The Year in Thoracic Anesthesia: Selected Highlights from 2016. J Cardiothorac Vasc Anesth, 2017, 31(3): 791-799.
17. Feneley RC, Hopley IB, Wells PN. Urinary catheters: history, current status, adverse events and research agenda. J Med Eng Technol, 2015, 39(8): 459-470.
18. 張滿, 靳智勇, 馬英, 等. 自主呼吸麻醉結合單孔非置管胸腔鏡技術在肺大皰切除術中應用的隨機對照試驗. 中國胸心血管外科臨床雜志, 2018, 25(3): 218-221.
19. Peng G, Liu M, Luo Q, et al. Spontaneous ventilation anesthesia combined with uniportal and tubeless thoracoscopic lung biopsy in selected patients with interstitial lung diseases. J Thorac Dis, 2017, 9(11): 4494-4501.
20. Li S, Jiang L, Ang KL, et al. New tubeless video-assisted thoracoscopic surgery for small pulmonary nodules. Eur J Cardiothorac Surg, 2017, 51(4): 689-693.
21. Gonzalez-Rivas D, Yang Y, Guido W, et al. Non-intubated (tubeless) uniportal video-assisted thoracoscopic lobectomy. Ann Cardiothorac Surg, 2016, 5(2): 151-153.
22. Gonzalez-Rivas D, Bonome C, Fieira E, et al. Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery? Eur J Cardiothorac Surg, 2016, 49(3): 721-731.
23. Watanabe A, Watanabe T, Ohsawa H, et al. Avoiding chest tube placement after video-assisted thoracoscopic wedge resection of the lung. Eur J Cardiothorac Surg, 2004, 25(5): 872-876.
24. Holbek BL, Hansen HJ, Kehlet H, et al. Thoracoscopic pulmonary wedge resection without post-operative chest drain: an observational study. Gen Thorac Cardiovasc Surg, 2016, 64(10): 612-617.
25. 袁江, 張永學, 高兆明. 劍突下單孔胸腔鏡與三孔胸腔鏡前縱隔腫瘤切除的臨床療效對比. 中國老年學雜志, 2017, 37(15): 3815-3817.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical application of tubeless trans-subxiphoid thoracoscopic surgery in anterior mediastinal tumor resection: A case control study

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