胸腔镜与胸骨正中劈开胸腺扩大切除治疗重症肌无力并胸腺瘤的比较

Comparison between video-assisted thoracoscopic extended thymectomy and trans-sternal thymectomy for myasthenia gravis with thymoma

回顾性分析51例重症肌无力（MG）并胸腺瘤患者的临床病理资料,其中31例接受胸腔镜手术（腔镜组）,20例接受胸骨正中劈开手术（开放组）。结果手术均顺利完成,腔镜组2例术中辅助小切口;两组术后各有1例发生肌无力危象,全组无围手术期死亡。腔镜组与开放组比较,手术时间、延迟拔管率、术后并发症发生率差异无统计学意义,术中失血量、引流管留置时间、术后住院时间较少,差异有统计学意义（P〈0.05）。随访时间6~53个月,中位时间23个月,失访4例。腔镜组患者完全缓解率为21.4%,有效率为78.6%,胸腺瘤复发率为7.1%,开放组分别为26.3%、84.2%、5.3%,两组差异无统计学意义。对于高选择性的MG并胸腺瘤患者,胸腔镜胸腺扩大切除术安全可行,能取得与胸骨正中劈开入路手术相近的远期疗效,且在术中出血、术后恢复方面存在优势。

The clinicopathologic data of 51 patients with thymomatous myasthenia gravis （MG） were analyzed re- strospeetively. Among them, 31 patients underwent video-assisted thoracoscoscopic extended thymeetomy （vats group）, and 20 patients underwent trans-sternal extended thymeetomy （open group） . All the 51 operations were successfully completed, and 2 cases in vats group were converted to open surgery. All groups had one case of MG crisis and had no death case. There was no significant differences in operation time, postoperative morbidity, and delayed pulling rate of tracheal intubation between the two groups. Intraoperatve bleeding, postoperative hospital stay and time of chest drainge tube left were significantly decreased in vats group compared to open group （ P 〈 0. 05）. Postoperative followed-up was performed to evaluate the long-term outcomes between the two groups. Fol- low-up data included 28 patients of vats group and 19 patients of open group were available, and median follow-up was 23 months （range 6 -53 months）. The complete stable remission, effective and recurrence rates were respec-tively 21.4%, 78.6% and 7. i% in the patients of vats group, and were respectively 26.3%, 84.2% and 5.3% in the patients of open group. There were no significant differences between the two groups for these factors. Video- assisted thoracoseoseopie extended thymeetomy is comparable with trans-sternal extended thymeetomy in both safety and curability for the treatment of MG with resectable thymoma, and with its specific advantages of less blood loss and rapid recovery.