Comparison Of The Clinical Efficacy Of Subxiphoid Approach And Unilateral Thoracic Approach Under Thoracoscopic Extended Thymectomy In The Treatment Of Thymoma

Objective:To explore the difference in clinical perioperative curative effect of the two surgical approaches under the subxiphoid approach and the unilateral thoracic approach in the treatment of thymoma.Methods:A complete collection of 208 patients who were admitted to our hospital from January 2018 to December 2020 who underwent minimally invasive thoracoscopic surgery and were clearly diagnosed as thymoma by pathology after surgery,and then strictly passed the inclusion and exclusion criteria before screening The subsequent71 patients were the main subjects of this study.Among the overall research subjects screened,22 cases were selected as the study group(group A),and the subxiphoid approach was strictly used for thoracoscopic extended thymectomy;the other 49 cases were classified as the control group(group B),and the single group was strictly used.Side-thoracic approach thoracoscopic extended thymectomy(left/right),collect the relevant important library of patients,compare the basic clinical information,oncology information,perioperative indicators,and complications of the two groups of patients,and then sort out statistics Based on scientific data,the difference in clinical efficacy of the two surgical options in the treatment of thymoma was analyzed.Results: The surgical time,intraoperative blood loss,drainage volume,drainage tube time,postoperative removal of tracheal intubation time,pain score on the first/second day after surgery,and mediastinal fat removal in the operation time,intraoperative blood loss,drainage tube time,postoperative pain score of thymoma under subxiphoid thoracoscopic extended resection.Completeness and size are better than unilateral thoracic approach thoracoscopic enlarged thymectomy(P<0.05),but the actually difference in the incidence of complications between the two groups(A/B)of patients is not statistically significant because of P>0.05.However,in terms of the overall incidence of postoperative complications,thoracoscopic surgery under the subxiphoid process is lower than that under the unilateral thoracic approach.Result:Through the analysis of the data of the two groups of different surgical plans,the SVAET group under the subxiphoid approach thoracoscopic extended thymectomy was completed in the time of the operation,the time of the tracheal intubation after the operation,the time of the ICU intensive care,the first and the first after the operation.The 2-day visual pain score,drainage tube indwelling time,completeness of mediastinal fat removal,and maximum length/width of postoperative specimens after deployment were better than those in the VATET group under unilateral thoracic approach thoracoscopic extended thymectomy,and there were differences It was statistically significant(P<0.05);there was no significant difference in the pain scores and antibiotic use time between the two groups of patients at 24 h after surgery,the third day after surgery and the day the drainage tube was removed(P>0.05);and the two groups There was no significant difference in the incidence of postoperative complications such as lung infection,arrhythmia,pleural effusion,myasthenia crisis,phrenic nerve injury,and chylothorax(P>0.05).In terms of the overall incidence of posterior chest complications,the overall incidence of postoperative complications in group A was lower than that in group B(P<0.05);there was no significant difference in the improvement of postoperative myasthenia gravis symptoms between groups A and B.(P>0.05);The size of the tumor resected in group A was not significantly different from that in group B,but the maximum length and width of the dissected adipose tissue specimens were larger than those in group B,and the difference was statistically significant(P<0.05).Conclusion:1.Compared with the unilateral thoracic approach group,there is no significant difference in intraoperative blood loss between the subxiphoid approach group and the unilateral thoracic approach group,but the operation time can be shortened;2.In the subxiphoid approach group,the tracheal intubation can be removed as soon as possible,which can reduce the pain in the first two days after surgery,shorten the time of ICU monitoring,remove the drainage tube as soon as possible,and can be discharged as soon as possible;3.There is no significant difference in various postoperative complications between the two groups of patients,but the overall chest complications rate of the subxiphoid approach is lower than that of the unilateral thoracic approach;4.There is no significant difference in the improvement of myasthenia gravis symptoms between the two groups of programs;5.There is no significant difference in the integrity of the two groups in the removal of the thymic tumor itself,but the subxiphoid approach has an advantage in the integrity of the surrounding adipose tissue.