胸腺瘤的微创及开放手术治疗

Minimally invasive and open surgery for thymoma

目的:评价微创及开放手术在胸腺瘤治疗的价值。方法:回顾性分析2008年1月至2012年4月我科手术治疗的33例胸腺瘤患者的临床资料。结果:33例胸腺瘤患者合并重症肌无力23例,全部进行扩大胸腺及胸腺瘤切除术。手术方式采取微创手术14例(胸腔镜手术6例,达芬奇机器人手术8例),开放手术19例(胸骨正中切口16例,后外侧切口3例)。肿瘤根治性切除32例,姑息性切除1例,肿瘤完整切除率97.0%(32/33)。微创组与开放组比较,微创组出血量明显少于开放组(P<0.05),手术时间及切除肿瘤直径两组间无明显差异(P>0.05)。微创组肿瘤分期为Ⅰ、Ⅱ期患者比例(13/14)明显高于开放组(11/19),差异有统计学意义(P<0.05)。两组患者均无住院死亡。术后共并发肌无力危象3例,胆碱能危象2例,心功能不全1例,并发症发生率18.2%,两组间无明显差异。微创组术后住院时间明显短于开放组(P<0.05)。1例胸腺癌术后1年发生双肺转移,无肿瘤局部复发。术后MG症状完全缓解1例,改善20例,改善不明显2例。结论:重症肌无力是胸腺瘤的常见伴随症状。手术为主的综合治疗效果良好,微创手术适合Ⅰ、Ⅱ期的胸腺瘤患者。

Objective：To compare the effect of minimally invasive and open surgery for thymoma.Methods：Totally 33 cases of thymoma underwent thymectomy by either minimally invasive surgery（Davinci Robotic Surgery and video assistant surgery） or open surgery in our department during January 2008 to April 2012.The clinical data was analysised retrospectively.Results：Of 33 cases 14 cases underwent minimally invasive approach,and 19 cases underwent open surgery.23 of 33 cases（69.7%） were complicated with myasthenia gravis preoperatively.32 of 33 cases accepted radical operation.The amount of blood loss and duration of postoperative hospital stay in the minimal invasive group were significantly lower than that in the open surgery goup.The ratio of patients with Masaoka stage Ⅰ and Ⅱ in the minimally invasive cohort（13/14） was significantly higher than that in the open cohort（11 /19）.Totally 6 cases（18.2%） occurred complications followed operation including myasthenic crisis in 3,cholinergic crisis in 2 and cardiac insufficiency in one.One case experienced bilateral lung metastasis 1 year after operation,and no case recurrence locally.The symptom of myasthenia gravis was completely disappeared in one patient and much improved in 20 cases.Conclusion：Myasthenia gravis is common in patients with thymoma.Surgical treatment for thymoma can make a good clinical results.Minimally invasive sugery is prefered for patients with thymoma by Masaoka staging Ⅰ,Ⅱ.