横断胸骨第二肋间小切口胸腺切除治疗重症肌无力引流管位置的对比研究

Comparative study of the location of draining tube in thymectomy by sternum transverse in second spatium intercostale incision in the treatment of myasthenia gravis

目的探讨横断胸骨第二肋间小切口胸腺切除术治疗重症肌无力不同位置置引流管的优缺点。方法 195例行胸腺切除术的MG患者,其中67例在两侧纵隔胸膜完整的情况下施行横断胸骨第二肋间小切口旁置纵隔引流管,88例纵隔胸膜破裂口较大者施行单侧腋中线第七肋间置胸腔引流管及40例两侧纵隔胸膜完整者施行剑突下置纵隔引流管。结果手术时间42～100(72.5±17.6)min,术后引流30～140(89.8±30.6)mL,48h内全部拔引流管,术后摄胸片未见明显胸腔积液或纵隔积液。切口Ⅰ/甲级愈合。术后随访1～12个月,胸骨愈合均满意,无"鸡胸"等畸形。结论施行横断胸骨第二肋间小切口旁置纵隔引流管手术操作简便、安全、创伤小,值得临床推广。

Objective To investigate the advantages and disadvantages of different locations of draining tube in thymectomy by sternum transverse in second spatium intercostale incision. Methods Mediastinal draining tube was located beside the sternum transverse in second spatiun intercostale incision in 67 cases which mediastinal pleura was complete.Thoracic draining tube was located on the seventh in tercostals of axillary midline in 88 cases which mediastinal pleura was ruptured.Mediastinal draining tube was located under the xiphoid in 40 cases which mediastinal pleura was complete. Results The operation time was（72.5±17.6）minutes.Drainage volume was（89.8±30.6）mL,and all of the draining tubes were pulled out in 48 hours.Chest or mediastinal pleural effusion was not obviously saw by X-chest after operation.IncisionⅠ/first class was healed.Sternum of the patients which were followed up 1 month to 12 months was healed and had no chicken breast and other deformities. Conclusion The operation method which mediastinal draining tube locates beside the sternum transverse in second spatiun intercostale incision is simple,safe,and less traumatic,so it is worth to be popularized.