3种不同术式治疗重症肌无力的比较

Comparisons of Three Different Types of Thymectomy for Non-Thymomatous Myasthenia Gravis

目的探讨不同时期不同手术方式治疗重症肌无力的疗效。方法回顾分析我院1991～2006年有随访资料的269例重症肌无力采用不同术式胸腺切除术治疗的临床资料,根据不同时期开展不同术式分为3组:胸骨劈开组(1991年1月～2002年5月,n=161)胸腔镜组(2002年2月～2005年7月,n=67)、胸腔镜联合颈部切口组(2005年2月～2006年11月,n=41)。结果胸骨劈开组手术时间(97.5±17.5)min显著短于胸腔镜组(130.3±31.5)min(q=12.991,P<0.05)和胸腔镜联合颈部切口组手术时间(152.2±33.9)min(q=18.005,P<0.05)。胸骨劈开组术后发生肌无力危象41例显著高于胸腔镜组4例和胸腔镜联合颈部切口组4例(χ2=14.394,P=0.000),但后2组肌无力危象发生率无统计学差异(χ2=0.532,P=0.466)。胸骨劈开组术后第1年完全稳定缓解率26.7%(43/161),与胸腔镜组25.4%(17/67)和胸腔镜联合颈切口组31.7%(13/41)差异无统计学意义(χ2=0.554,P=0.758)。胸骨劈开组术后第2、3年的完全稳定缓解分别为31.7%(51/161)、35.4%(57/161),与胸腔镜组无统计学差异31.3%(21/67)、43.3%(29/67)(χ2=0.002,P=0.961;χ2=1.251,P=0.263)。结论胸腔镜下胸腺切除术能取得胸骨正中劈开手术同样理想的中远期治疗效果,胸腔镜联合颈部切口胸腺切除术是否能够提高远期疗效,有待进一步随访观察。

Objective To assess the efficacy of different types of-thymectomy for the treatment of myasthenia gravis （MG）. Methods A retrospective analysis on 269 cases of MG, who were treated in our hospital from 1991 to 2006 by transsternal thymectomy （January 1991 to May 2002, n = 161）, thoracoscopic thymectomy （February 2002 to July 2005, n = 67）, or video-assisted thoracoscopic extended thymectomy （VATET, February 2005 to November 2006, n = 41 ）. Results The mean operation time of the transsternal group was significantly shorter than that in the other groups [ transsternal group vs thoracoscopic and VATET groups ： （97.5±17.5） minvs （130.3 ±31.5） min （q =12.991, P〈0.05） and （152.2 ±33.9） min （q =18.005, P〈0.05）]. 41 patients in the transsternal group developed myastbenic crisis that was significantly more than that in the other two groups （4 in both, X^2 = 14. 394, P = 0. 000）. No significantly difference was found in the myasthenic crisis between the thoracoscopic and VATET groups （X^2 = 0. 532, P = 0. 466）. The rate of 1-year complete stable remission in the transsternal group was 26.7% （43/161） , which was not significantly different from that in the other two groups [ Thuracoscopic group ： 25.4% （ 17/67 ） , VATET group ： 31.7% （ 13/41 ）, X^2 =0. 554, P =0. 758]. While the rates of the 2- and 3-year complete stable remission in the transsternal group was 31.7% （51/161） and 35.4% （57/161）, which were not significantly different from that in the thoracoscopic group [31.3% （21/67）, X^2 =0. 002, P = 0. 961 and 43.3% （ 29/67 ）, X^2 = 1. 251, P = 0. 263, respectively ]. Conclusions The mid-term outcomes of thoracoscopic and transsternal thymectomy are similar for the patients with MG. Long-term observation is necessary to evaluate the efficacy of VATET.