The types of tumors in the medial mediastinal area were different. Thymoma, germ cell tumors,
ectopic parathyroid tumors, and lymphoid tumors were in the anterior mediastinum. Bronchial
cysts, pericardial cysts, and lymphomas were in the middle mediastinum. The principles of
treatment for mediastinal tumor surgery must be both safe and radical. Radical resection is
the dominant position in the treatment of mediastinal tumors, including traditional open
surgery and thoracoscopic assisted minimally invasive surgery. At present, minimally invasive
surgery for mediastinal tumor includes video-assisted thoracoscopic surgery via subxiphoid
approach, left or right intercostal approach, trans-cervical approach and "Da Vinci" robotic
system. Compared with conventional sternotomy, thoracoscopic assisted minimally invasive
mediastinal tumor resection has clearer, multi-angle surgical vision, less trauma, less
intraoperative blood loss, early postoperative extubation, and short postoperative hospital
stay, postoperative recovery faster, less pain, fewer complications and meet the beauty needs
and so on. Thoracoscopic assisted mediastinal thymectomy is currently one of the most
commonly used surgical methods, but there are some deficiencies.
Minimally invasive surgery through the subxiphoid approach can achieve a good surgical field
of vision. Compared with the traditional transcostal VATS medial mediastinal tumor resection,
the subxiphoid thoracoscopic surgery had obvious advantages: (1) The surgical field is fully
exposed. For patients with myasthenia gravis, it is particularly necessary to clean bilateral
mediastinal adipose tissue; (2) Without intercostal surgery, damage to intercostal nerves can
be avoided, postoperative pain can be reduced, and quality of life can be improved; (3)
Operation time, intraoperative blood loss, postoperative Extubation time is similar to VATS.
Disadvantages are as follows: (1) If there is a large hemorrhage during surgery, an emergency
transfer to open the chest is required. The injury is greater and the operation is more
troublesome; (2) Anterior septal space is Smaller, surgical instruments are more likely to
interfere with each other. But there is still lack of evidence to prove which is better.
In this study, 100 patients with anterial and middle mediastinal tumors were selected as
study subjects. 50 patients undergoing subxiphoid uniportal VATS were included in the
observation group, and 50 patients undergoing intercostal uniportal VATS were included in the
control group. The operation time, incision length, intraoperative blood loss, postoperative
drainage time, postoperative drainage, hospitalization and hospitalization costs of the 2
groups would be observed. The clinical efficacy and incidence of complications were compared
between the 2 groups. After six months of follow-up, postoperative pain and postoperative
quality of life were observed in the 2 groups.