微创技术在胸腺瘤并重症肌无力外科治疗中的应用

Application of Minimally Invasive Surgery in Patients with Thymomas and Myasthenia Gravis

目的对胸腔镜与传统手术治疗胸腺瘤合并重症肌无力患者的临床情况和安全性进行比较分析,为临床术式的选择提供参考。方法选取经CT或PET-CT、新斯的明实验以及肌电图检查确诊为胸腺瘤合并重症肌无力患者82例,随机分为胸腔镜治疗组和传统手术治疗组各41例。术后记录两组患者的临床症状并进行随访。记录两组患者术中出血量、手术时间、术后止痛药使用情况、住院时间、重症肌无力治疗效果和术后并发症,以及肿瘤复发和患者死亡情况。结果胸腔镜组患者术中出血量、手术时间、切口大小、止痛药使用情况、引流管留置时间和引流量,以及住院时间均较传统手术组少,明显优于传统手术组,差异具有统计学意义(P<0.05)。胸腔镜组患者术后重症肌无力症状有效缓解36例,有效率87.8%,传统手术组患者术后有效33例,有效率80.5%,两组患者有效率差异无统计学意义(P>0.05)。胸腔镜组患者术后并发症1例,不良反应1例;传统手术组患者术后并发症发生7例,不良反应7例。两组患者并发症和不良反应发生率差异具有统计学意义(P<0.05)。两组患者术后复发各1例,胸腔镜组6年内死亡1例,传统手术组死亡2例。肿瘤复发率和病死率均无统计学意义(P<0.05)。结论胸腔镜对胸腺瘤合并重症肌无力患者治疗的临床恢复情况好,术后并发症少,可推广成为胸腺瘤合并重症肌无力患者手术治疗的首选方法。

Objective To compare the thoracoscopy and traditional surgery for the patients with thymoma and myasthenia gra- vis, and provide reference for the choice of clinical surgical procedures. Methods Total 82 patients with thymoma and myasthe- nia gravis were divided to thoracoscopy group and traditional surgery group（ n = 41 each）. The clinical symptoms, dose and dura- tion of drainage, operation time,wound size, blood loss, analgesic use, effective of myasthenia gravis and adverse reaction was ob- served. All patients were follow-up for 6 years to observe the recurrence rate of tumor and mortality. Results The dose and dura- tion of drainage, operation time, wound size, blood loss and analgesic use in the thoracoscopy group was lower than that in the oth- er group（P 〈 0.05 ）. The effective rate was 87.8% （ 36/41 ） in the thoraeoscopy group, and 80.5% （ 33/41 ） in the traditional surgery group,P 〉0.05. The occurrence of complications was 1 case in the thoracoscopy group and 7 cases in the traditional sur- gery group ; and the occurrence of adverse reactions was 1 case in the thoracoseopy group and 7 cases in the traditional surgery group（ P 〈 0.05 ）. In the thoracoscopy group, 1 case was with recurrence of tumor, and 1 case died in 6 years;in the traditional surgery group, 1 case was with recurrence of tumor, and 2 cases died in 6 years ; the differences in the occurrence rate and mortali- ty between the two groups was not significant（P 〉 0.05 ）. Conclusion Thoracoscopy surgery is a safe method for the thymoma combined with myasthenia gravis,which can decrease the incidence of the complications and adverse reactions. It can be widely used in the treatment of thymoma combined with myasthenia gravis.