三种小切口行胸腺切除治疗重症肌无力的对照分析

Comparisons of three minl-incision surgery in thymectomy for myasthenia gravis

目的比较三种小切口行胸腺切除治疗重症肌无力的手术效果，合理选择手术方式。方法回顾性分析行胸腺切除术治疗109例重症肌无力患者的临床资料，根据手术切口方式的不同分为胸骨部分劈开组、横断胸骨组和胸腔镜组，比较三组的手术时间、术中出血量、术后胸腔引流量及时间、术后住院时间、术后肺部感染及切口感染、术后肌无力危象、术后慢性疼痛上肢运动障碍和疗效。结果胸腔镜组术中出血量[（77．5±18．0）ml]、术后胸腔引流量[（100．8±11．8）ml]、术后胸腔引流时间[（2．3±0．5）d]、术后切口感染率（0）优于横断胸骨组[分别为（97．4±14．3）ml、（175．8±18．3）ml、（3．1±0．7）d、6．2％（2／32）]及胸骨部分劈开组[分别为（130．1±24．0）ml、（379．0±45．6）ml、（4．2±0．6）d、13．8％（9／65）]（P〈0．05），同时横断胸骨组又优于胸骨部分劈开组（P〈0．05）；胸腔镜组术后肺部感染、术后肌无力危象、术后慢性疼痛上肢运动障碍的发生率及术后住院时间均优于横断胸骨组及胸骨部分劈开组（P〈0．05）。结论三种小切口手术方式安全可行，疗效显著，胸腔镜切口手术有着显著的优越性，值得在各大中型医院广泛推广；而对于技术设备不发达的基层医院，横断胸骨切口为更好的选择。

Objective To investigate the best operative approach in the treatment of myasthenia gravis （MG） by comparing surgical effects of median sternotomy, trans-sternal surgery and video-assisted thoracoscope surgery （VATS）. Methods One hundred and nine patients who received thymectomy for MG were divided into median sternotomy group,trans-sternal group and VATS group according to the way of operative incision. The clinical features, such as operative time, operative blood loss, postoperative drainage volume and drainage time,postoperative hospitalization time, postoperative pulmonary infection, incisional infection, MG crisis, postoperative chronic pain and upper limb＇s movement disorder were retrospectively analyzed to evaluate the effect of the surgery. Results The operative blood loss, postoperative drainage volume and drainage time, and incisional infection in VATS group [ （77.5 ± 18.0 ） ml, （100.8 ± 11.8 ） ml, （2.3 ± 0.5 ） d, 0 ] were superior to those in trans-sternal group [ （97.4 ± 14.3 ） ml, （ 175.8 ± 18.3 ） ml, （3.1 ± 0.7） d,6.2%（2/32）] and median sternotomy group [ （130.1± 24.0） ml, （379.0 ± 45.6） ml, （4.2 ± 0.6） d, 13.8% （9/65）] （P 〈 0.05）,and median stemotomy group was the worst. The incidence of postoperative pulmonary infection, MG crisis, upper limb＇s movement disorder and postoperative hospitalization time in VATS group were superior to those in trans-sternal group and median sternotomy group （P 〈0.05）. Conclusions Three mini-incision surgical approaches are safe, feasible and effective. VATS is moreadvantageous and is worth popularizing in large and medium-sized hospitals. Trans-sternal surgery is the better choice for.primary hospitals without advanced technology and equipments.