人工气胸辅助胸腔镜下胸腺切除术29例临床分析

Clinical analysis on 29 cases of thoracoscopic thymectomy assisted by artificial pneumothorax

目的探讨人工气胸辅助单孔或多孔胸腔镜下胸腺切除术的可行性及疗效。方法回顾性分析徐州市中心医院2011年1月至2015年12月行人工气胸辅助胸腔镜下胸腺切除术29例患者的临床资料,并与同期行常规胸腔镜手术的41例患者比较,分析手术时间、术后并发症、胸管引流及术后住院时间的差异。结果人工气胸辅助胸腔镜手术组与常规胸腔镜手术组的手术时间分别是(79.3±20.7)min、(82.6±31.5)min,胸管引流时间分别是(1.5±0.7)d、(1.2±0.9)d,胸管引流量分别是(138.2±26.5)ml、(150.6±38.2)ml,术后住院时间分别是(7.5±2.6)d、(8.2±3.1)d,差异均无统计学意义(P>0.05);人工气胸辅助手术的患者术后发生并发症2例次,较常规胸腔镜手术组的12例次显著减少(P<0.05);合并肌无力的患者术后症状得到有效控制。结论人工气胸辅助胸腔镜下胸腺切除术是可行有效的,同时可减少术后并发症。

Objective To explore the feasibility and efficacy of single-port and multiple-port thoracoscopic thymectomy assisted with artificial pneumothorax （ AP-VATS）. Methods A total of 29 eases received APVATS from January 2011 to December 2015 admitted by Xuzhou Central Hospital were retrospectively analyzed, compared with 41 patients who received conventional VATS thymectomy during this period. And the operative time, postoperative complications, chest drainage and postoperative hospital stay of the groups were compared respectively. Results The primary outcomes in AP-VATS group were comparable with that of VATS group, in terms of operative time （ 79. 3± 20. 7 ） min vs. （ 82. 6 ±31.5 ） min, chest drainage time （ 1.5 ± 0.7 ） d vs （ 1.2 ±0.9） d, chest drainage volume （ 138.2 ± 26. 5 ） ml vs. （ 150. 6 ±38. 2 ） ml and postoperative hospital stay （ 7. 5 ± 2. 6） d vs. （8. 2 ±3. 1 ） d, without significant difference （P 〉0. 05）. However, total postoperative complications of AP-VATS group were encouragingly reduced than that of VATS group （P 〈 0. 05）. Besides, the myasthenia gravis was controlled and alleviated effectively duringthe follow-up. Conclusions AP-VATS thymectomy is feasible, efficacious and comparable to normal VATS, probably with less postoperative complications.