2023 年第 5 期 第 18 卷

改良剑突下三切口胸腔镜手术治疗纵隔疾病的效果

Effect of modified subxiphoid thoracoscopic surgery with three incisions on mediastinal diseases

作者：莫安胜李景华田烨覃桂军

英文作者：Mo Ansheng Li Jinghua Tian Ye Qin Guijun

单位：广西医科大学附属武鸣医院心胸外科，南宁530199

英文单位：Department of Cardiothoracic Surgery Wuming Hospital of Guangxi Medical University Nanning 530199 China

关键词：经剑突下胸腔镜手术；纵隔疾病；外科手套；切口保护器

英文关键词：Subxiphoidthoracoscopicsurgery;Mediastinaldiseases;Surgicalglove;Incisionprotector

• 摘要：

• 目的 观察改良剑突下三切口胸腔镜手术治疗纵隔疾病的效果。方法 2020年8月至2023年1月广西医科大学附属武鸣医院对16例前纵隔疾病患者采用改良剑突下三切口胸腔镜手术进行治疗。在剑突下做2～3 cm切口为观察孔，置入切口保护器（充分利用切口），用无菌乳胶手套封闭切口保护套（防漏气），制作人工二氧化碳气胸。根据手术需要确定无菌乳胶手套的Trocar数量和型号；双侧锁骨中线与肋弓交点下分别做切口置入Trocar作为操作孔进行手术。观察手术效果。结果  16例纵隔疾病患者采用改良剑突下三切口胸腔镜手术方法完成治疗，手术顺利，手术时间为（232±21）min、范围120～370 min，无一例发生严重手术并发症，术后恢复良好。所有患者随访至2023年1月18日能够正常生活。结论   改良剑突下三切口胸腔镜手术技术克服了传统剑突下三切口胸腔镜手术技术切口使用不充分、镜头活动范围局限、不能进更多器械等方面的不足，更易于使用。

• Objective  To observe the effect of modified subxiphoid thoracoscopic surgery with three incisions on mediastinal diseases. Methods From August 2020 to January 2023, 16 patients with anterior mediastinal diseases were treated with modified subxiphoid thoracoscopic surgery with three incisions in Wuming Hospital of Guangxi Medical University. A 2-3 cm incision under the xiphoid process was made as the observation hole, the incision protector was placed (full use of the incision), the incision protective sleeve was sealed by sterile latex gloves (air leakage prevention), and the artificial carbon dioxide pneumothorax was made. The number and model of Trocar of sterile latex gloves were determined according to the needs of operation. Under the intersection of bilateral clavicular midline and costal arch, incision was made and Trocar was placed as the operation hole for operation. The effect of operation was observed. ResultsSixteen patients with mediastinal diseases were treated with modified subxiphoid thoracoscopic surgery with three incisions. The operation was smooth, the operation time was (232±21)min and the range was 120-370 min. There were no serious surgical complications and good recovery after operation. All patients were followed up until January 18, 2023, and were able to live normally. Conclusion The modified subxiphoid thoracoscopic surgery technology with three incisions overcomes the shortcomings of the traditional subxiphoid thoracoscopic surgery with three incisions such as insufficient use of incisions, limited range of lens movements and inability to access more instruments, and it is easy to use.