| Objective:By comparing and analyzing the effects of acute and chronic pain scores and near-term postoperative quality of life scores after subxiphoid and intercostal thoracoscopic expanded thymus resection in anterior mediastinal space occupying patients,this paper aims to explore whether subxiphoscopic thoracoscopic expanded thymus resection can further reduce the occurrence of acute and chronic postoperative pain and improve the near-term postoperative quality of life.Methods:Retrospective analysis was performed on the clinical medical records of 153 patients who underwent thoracoscopic enlarged thymectomy in the Department of Thoracic Surgery of Anhui Provincial Hospital from July 2020 to June 2022.Thirty patients have undergone subxiphoidapproachvideo-Assistedclinical anesthesia surgery(SVATS),123patients have undergone endoscopic video-assisted thoracoscopic thymus surgery(VATS),we have paired patients in the 2 groups by the propensity score method,and eventually enrolled 60 patients,30 of whom underwent subxiphoid approach,30 of whom underwent intercostal approach,30 of whom were males and 30 of whom were females.The mean age was 50.78±12.127 years old.General clinical data of the two groups were collected.The postoperative pain of the two groups was evaluated by Numericratingscale NRS at the 1st day,2nd day,3rd day,1st week,2nd week,3rd month and 6th month,respectively.The QLQ-C30 Evaluation Scale questionnaire of the European Organization for Research and Treatment of Cancer(EORTC)was used in both groups at week 1,2,4 and 8 to evaluate the quality of life before and after surgery.The clinical case characteristics,intraoperative conditions and postoperative pain incidence of the two groups were compared by statistical T-test and x~2test.The QLQ-C30 quality of life scores of the two groups before surgery and at 1,2,4 and 8weeks after surgery were analyzed by repeated measure variance.Results:In the comparison of general clinical data,there was no statistical difference between the subxiphoid group and the intercostal group(p<0.05),and no patients died during perioperative period.Compared with the transcostal group,the subxiphoid group had no statistically significant differences in NRS score at the time of operation and 2 weeks after operation(p>0.05).In terms of intraoperative blood loss,the subxiphoid group was more than the intercostal group(p<0.05),and the postoperative drainage volume was less in the subxiphoid group than the intercostal group(p<0.05).The length of postoperative catheterization and postoperative hospital stay in subxiphoid group was shorter than that in intercostal group(p<0.05).The NRS score in subxiphatic group was lower than that in intercostal group on day 1,2,3,1 week,3 months and 6 months after surgery,and the difference was significant(p<0.05).Multivariate analysis of patients with or without diagnosis of chronic pain showed that 3 months after surgery,chronic pain risk factors included:NRS score on the 3rd day after surgery,NRS score on the 2nd week after surgery,and surgical method(p<0.05).At 6 months after surgery,chronic pain risk factors included:NRS score at 2 weeks after surgery and surgical method(p<0.05).There was no significant difference in the preoperative QLQ-C30quality of life score between the subxiphoid group and intercostal group.Compared with intercostal group,patients in subxiphoid group had better QLQ-C30 life quality scores at 1,2,4 and 8 weeks after surgery in physical function,social function,emotional function and overall health status(p<0.05).Fatigue and pain scores in the QLQ-C30 quality of life score in the subxiphoid group were lower than those in the transcostal group(p<0.05).Conclusion:(1)SVATS can achieve the safety of transcostal thoracoscopic surgery,in which SVATS has more advantages in postoperative drainage volume,postoperative catheterization time,and postoperative hospital stay than the transcostal thoracoscopic extended thymectomy.(2)The NRS score of SVATS was lower at day 1,2,3,1 week,3 months,and 6 months after surgery,and the pain symptoms were less severe in the SVATS group than in the patients undergoing the intercostal thoracoscopic enlarged thymectomy.In addition,poor pain control on the 14th day after surgery is a risk factor for chronic pain.(3)SVATS can better improve patients’postoperative quality of life and faster recovery compared with intercostal thoracoscopic enlarged thymectomy. |
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