General Information
All records of patients’ identities included in this study will be kept in hospitals as required, and public reports on the results of the study will not disclose all records of patients’ identities. All patients had informed consent before being enrolled in the group, fully communicated with the patients before the experiment, introduced the content and process of the experiment, related risks, and possible adverse reactions, signed the informed consent form after obtaining the consent of the patients, and informed the patients of the test results in strict accordance with the experimental procedures. Eighty patients with anterior mediastinal teratoma who underwent surgery in our hospital from May 2019 to May 2021 were selected as the subjects of this prospective study. According to the random residue grouping method, they were divided into a control group and an observation group with 40 cases each. General data such as gender and age of the two groups of patients did not affect this test, as shown in Table 1.
Inclusion and Exclusion criteria
Inclusion criteria: ①All patients in this study met the "Chinese Expert Consensus on Chest Wall Tumor Resection and Chest Wall Reconstructive Surgery (2018 Edition)" [8] diagnostic criteria for anterior mediastinal teratoma; ②All patients underwent chest CT scan and enhancement before surgery The scan was clearly an anterior mediastinal tumor. The tumor showed limited lesions and a clear boundary with surrounding tissues. It can be completely removed at one time. The diameter of the tumor is less than or equal to 5cm and the relationship with the surrounding organs is clear. There is no obvious invasion with or without severe weakness; ③The preoperative coagulation function, blood biochemistry, arterial blood gas, cardiac ejection fraction, lung function, etc. meet the surgical requirements, expected Can tolerate one-lung ventilation and general anesthesia. Exclusion criteria: ①The tumor diameter is greater than 5cm and the relationship with the surrounding organs is clear, there is obvious invasion, with or without severe weakness, and previous pleural inflammation; ②The general condition is poor and cannot tolerate one-lung ventilation; respiratory dysfunction FEV1 <1L, patients with multiple organ dysfunction such as cardiac dysfunction (≥grade 3), patients with coagulation dysfunction; ③ poor general conditions, accompanied by severe heart, lung, liver, kidney and other important organs with severe organic disease, With a history of organic brain disease and a history of mental illness.
Methodology
Among them, the control group underwent traditional surgical procedures, that is, patients were given general anesthesia, double-lumen endotracheal intubation, single-lung ventilation, 30° lateral decubitus position, suspension of the upper limbs; incision length ~1cm at the anterior axillary line at the fifth intercostal position 2cm is used as a mirror hole, and a 2~3cm incision is made at the midline of the ischial at the 3rd intercostal or 5th intercostal position as an operating hole, carbon dioxide (CO2) is filled in to create an artificial pneumothorax, and the position of the incision is adjusted appropriately according to the position of the tumor; Take the right approach as an example. Take an electric hook through the lower pole of the thymus and dissociate with an ultrasonic knife. At the same time, open the mediastinal pleura at the surface of the pericardium, and then move upwards along the phrenic nerve and the internal mammary artery to the superior vena cava and the internal mammary artery. At the junction, free to the thymus arteries and veins, take the titanium clip to clamp the severance, and remove the thymus, and then completely stop the bleeding, place a closed drainage tube, and suture layer by layer.
The observation group performed a modified subxiphoid thoracoscopic surgery, that is, the patient was placed in a supine position, and after successful single-lumen endotracheal intubation anesthesia, the upper abdomen and chest were sterilized and spread. Take the midline of the rectus abdominis under the xiphoid process and cut the skin 2cm longitudinally as the observation hole. The surgeon uses his fingers to close the xiphoid process and bluntly separates the posterior sternal space upwards. Insert a 5mm Trocar into a 0.5cm incision, insert a grasping forceps and an ultrasonic knife, insert a 10mm Trocar into the observation hole, put a 30° thoracoscope into the observation hole, continue to inject CO2, maintain a pressure of 8-10mmHg, and push away the double Lateral lung tissue, revealing the innominate vein, the tissue between the phrenic nerve and the pericardium. Cut the mediastinal pleura with an ultrasonic knife, and remove the side of the pericardium, above the diaphragm, and between the bilateral phrenic nerve and the innominate vein from bottom to top along the mediastinal pleura. The anterior mediastinal adipose tissue in the area carefully identifies and protects the superior vena cava, innominate vein, and phrenic nerve. The thymic vein was cut off, and then a total thymectomy was performed, and then the specimen was taken out. After the operation, a drainage tube was placed in the observation hole and the wound was sutured. Both groups were given anti-infective treatment. see image 1.
Follow-up and observation indicators
The levels of neuropeptide Y (NPY), 5-hydroxytryptamine (5-HT), and other pain-causing factors in the peripheral blood of the two groups of patients before and on the first day after surgery, peripheral blood nitric oxide (NO) and interleukin- β (IL-β), interleukin-6 (IL-6) and other pain stress index levels; enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of NPY, PGE2, 5-HT, IL-6, IL-β, The nitrate reductase method was used to detect the level of NO, and the visual analog scoring method was used to evaluate postoperative pain.
Statistical Analysis
All statistical data in this study were entered into the excel software by the first author and the corresponding author respectively. The included data were tested by the Shapiro-Wilk method. The measurement data that conformed to the normal distribution were described by the mean ± standard deviation (x̄±S), and between groups or the independent sample or paired-sample t-test was performed within the group, and the count data were described in integers or percentages (%), and the χ2 test was used between or within groups. The included data that do not conform to the normal distribution is described by M(QR), using Mann-Whitney-test, and the test level is α=0.05.