胸腔镜与胸骨正中切口行胸腺切除治疗重症肌无力的早期疗效比较

Comparison of the Early Outcomes of Extended Thymectomy for Myasthenia Gravis Between Video-assisted Thoracoscopic Surgery and Median Sternotomy

目的比较电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)与胸骨正中切口胸腺扩大切除治疗重症肌无力的早期疗效,以合理地选择手术方式。方法回顾性分析我科1998年7月至2007年5月行胸腺扩大切除术治疗195例重症肌无力患者的临床资料,根据不同的手术方式将其分为VATS组(2002年4月至2007年5月,83例)和正中切口开胸组(1998年7月至2007年5月,112例)。采用独立样本t检验分析手术时间、术中出血量、术后引流量、危象持续时间(肌无力危象时机械通气时间)等指标,采用χ2检验分析术后肌无力危象发生率。结果VATS组患者手术后胸腔引流量较正中切口开胸组增加(164.65±38.19mlvs.98.26±26.84ml,P=0.023),手术中出血量较正中切口开胸组减少(53.24±11.69mlvs.97.37±24.61ml,P=0.036);VATS组术后肌无力危象发生率为4.82%(4/83),正中切口开胸组为13.39%(15/112),两组间比较差异有统计学意义(P=0.046,OR=3.054)。VATS组术后发生危象所需机械通气时间较正中切口开胸组明显缩短(75.33±39.31hvs.189.20±89.74h,P=0.012)。结论VATS胸腺扩大切除术治疗重症肌无力安全性好,术中出血少,手术创伤小,能减少术后肌无力危象的发生,缩短术后肌无力危象所需的机械通气时间,有良好的应用前景。

Objective To investigate the value of video-assisted thoracoscopic surgery （VATS） in the treatment of myasthenia gravis （MG） by comparing the early clinical outcomes of extensive thymectomy of VATS and median sternotomy. Methods 195 patients who received extended thymectomy for MG from July 1998 to May 2007 in our department were divided into two groups by operative approach, 83 patients in the VATS group （from April 2002 to May 2007） and 112 patients in the full median sternotomy group（from July 1998 to May 2007）. The clinical features, such as operative time, operative blood loss, postoperative drainage, the incidence of crisis, duration of crisis （time of mechanical ventilation）, were retrospectively analysed by independent samples t test or chi-square test to evaluate the early outcomes. Results The postoperative drainage in the VATS group was more than that in the median sternotomy group （164. 65±38. 19ml vs. 98.26±26. 84ml, P=0. 023）, and the operative blood loss in the VATS group was less than that in the median sternotomy group（53.24±11.69ml vs. 97.37±24.61ml, P=0. 036）. The incidence of crisis in the VATS group was 4.82% （4/83）,which was less than that in the median sternotymy group El3.39%（15/112）, P=0. 046, OR= 3. 054]. And the persistence time of mechanical ventilation for post-operative crisis in the VATS group was much shorter than that in median sternotomy group （75.33± 39. 31h vs. 189.20± 89.74h, P=0. 012）. Conclusion VATS extended thymectomy for myasthenia gravis is safe and less invasive. It can decrease the incidence of crisis and the time of mechanical ventilation of crisis, as well as decreasing operative blood loss.