Clinical Study Of Single-Hole Thoracoscope Through Xiphoid Process For Single Pulmonary Bullae Resection

ObjectiveThe purposed of this study was to analyze the clinical effect and standard of the patients undergoing single-hole thoracoscopic pneumonectomy through xiphoid process.To judge the advantages and disadvantages and the general development trend of thoracoscopic sub-xiphoid approach compared with trans-intercostal one-hole thoracoscopic pneumonectomy.MethodsFrom January 2018 to January 2019,a total of 52 patients with unilateral bullae of the lung underwent surgical treatment in the same group of thoracic surgery of our hospital were enrolled.The eligible patients were randomly divided into the xiphoid process,intercostal and intercostal approach groups.The sub-xiphoid process group underwent single-port thoracoscopic lung bulla resection,and the intercostal group underwent single-port thoracoscopic lung bulla resection.The time of operation,the amount of bleeding during operation,the total drainage,the time of extubation,the grade of pain after operation and the changes of C-reactive,creatine kinase and myoglobin on the 1st,3rd and 5th day after operation were collected and compared.ResultsNone of the two groups died during the perioperative period,and there were no obvious complications.All patients were discharged from the hospital in stable condition after removing the thoracic drainage tube.Comparison of Xiphoid Process Group and Intercostal Group.There was no significant difference in operation time,amount of bleeding during operation,total flow after operation,time of indwelling chest tube(P>0.05).The mean VASmax of the xiphoid group was 6.4±1.0 and 5.6±0.6 on the 1st and 2nd day after operation,and the average VASmax was 7.7±0.6 and 7.3±0.6 on the 1st and 2nd day after operation in the intercostal group.The difference of VASmax between the two groups was statistically significant(P<0.05).The average CRP of the xiphoid group was 23.9±9.8,50.5±14.8,and the average CRP of the intercostal group was 1 and 3 days after operation.The difference was 36.4±19.4 and 63.4±16.0 respectively.The difference of CRP between the two groups was statistically significant(P<0.05).The average CK of the lower xiphoid group was 615.4±1,3 and 5 days after operation.173.8,433.3±256.9,244.4±53.1,the mean CK of the intercostal group was 834.4±227.8,604.1±180.2,310.9±65.7 at 1,3,and 5 days after operation,respectively.The difference was statistically significant(P<0.05);the mean Myo was 73.4±35.8 on the 1st day after operation in the xiphoid group,and the mean Myo was 149.1±69.0 on the 1st day after operation in the intercostal group.The difference was statistically significant(P<0.05).ConclusionThe trans-xiphoid approach has some advantage over the intercostal approach in reducing the risk of injury to the body and alleviating post-operative pain.Then we can increase the proportion of patients,promote the lung re-expansion,and achieve the goal of rapid rehabilitation.