胸腔镜与开胸手术治疗早期胸腺瘤的临床疗效比较

Clinical outcomes of thoracoscopic thymectomy versus open surgery for early-stage thymoma

回顾比较我院2008年6月至2012年12月行胸腔镜（24例）和经胸正中切口（19例）行胸腺瘤切除术治疗患者的临床资料.腔镜组的手术时间、失血量、术后住院时间、胸液引流时间及引流量等方面明显优于开胸组,差异有统计学意义（均P ＜0.05）.腔镜组总并发症发生率4％（1/24）,少于开胸组（4/19）,但差异无统计学意义（P＞0.05）.开胸组中合并重症肌无力者总有效缓解比例为7/9,与开胸组（6/8）相当（P＞0.05）;腔镜组随访23例,无复发或转移,生存率100％（23/23）,开胸组随访17例,复发或转移1例、死亡1例,生存比例16/17 （P ＞0.05）.提示胸腔镜行胸腺瘤切除术创伤小、并发症少、恢复快,具有和开胸手术相似的近期疗效,是安全、可行、临床效果好的微创术式.

From June 2008 to December 2012,video-assisted thoracoscopic surgery （VATS group） was performed for 24 cases of thymoma.Their operative procedures,postoperative complications,remission of myasthenia gravis （MG）,perioperative mortality and oncological outcomes were compared with 19 cases of trans-sternal open thymectomy （OT group）.Compared with OT group,VATS group had significantly shorter operation duration,less blood loss,shorter postoperative hospital stay,shorter chest tube duration and less chest drainage amount （P 〈 0.05）.The total rate of postoperative complications of VATS group was 4% （1/24） and it was less than OT group （4/19） without significant difference （P 〉0.05）.The effective remission rate of thymomatous MG was 7/9 in VATS group and it was similar to that in OT group （6/8,P 〉 0.05）.VATS group had a recurrent or metastatic rate of 0% （0/23） and it was better than OT group with 1/17.And there was no significant inter-group difference （P 〉 0.05）.The total survival rate of VATS group was 100% and it was similar to that of OT group （16/17,P 〉 0.05）.Thoracoscopic thymectomy is safe,feasible,efficacious and mini-invasive for thymoma.With fewer complications and a quicker recovery,it has similar short-term outcomes to conventional open thymectomy.