胸腔镜下胸腺扩大切除术治疗重症肌无力的临床研究

Clinical Analysis of VATS Extended Thymectomy for Myasthenia Gravis

目的:回顾性比较胸腔镜手术入路(VATS组)和胸骨正中入路(TS组)行胸腺扩大切除术治疗重症肌无力(MG)的短期及长期治疗效果,探讨VATS行胸腺扩大切除术治疗重症肌无力的临床价值。方法:共入组83例患者,其中VATS组50例、TS组33例;比较两组患者在手术时间、术中出血量、24h胸腔引流量、胸管留置时间、术后住院时间、术后并发症、术后肌无力危象和完全缓解率(CSR)等方面的异同。结果:VATS组手术时间(110.8±38.06)min、术中出血量(68.5±16.22)ml、24h引流量(110.0±35.50)ml、胸管留置时间(3.6±1.25)d、术后住院天数(9.8±1.85)d等优于TS组的(199.0±36.05)min、(205.8±34.55)ml、(326.3±56.22)ml、(5.6±1.19)d、(16.1±13.3)d;VATS组肺部感染率(7.5%)低于TS组(25.8%);VATS组2例发生术后肌无力危象,TS组有5例肌无力危象。平均随访57.5个月,VATS组完全缓解率为51%,TS组为52.9%,两组比较差异无统计学意义(P=0.654)。结论:VATS行胸腺扩大切除术治疗重症肌无力具有较好的长期有效率,而且具有术后肌无力危象发生率低、手术并发症少、术后出血少、住院时间短等优点,是安全有效的选择。

Objective： The purpose of this study was to compare perioperative outcomes in patients who underwent vid- eo-assisted thoracoscopic surgery （VATS group） or transsternal thymectomy surgery （TS group） and assess the VATS treatment for the myasthenia gravis. Methods： A total of 83 patients were enrolled, including 50 cases in VATS group and 33 cases in TS group;the two groups were compared in duration of surgery, amount of blood loss, thoracic drainage volume of first-24-hours, duration of chest drainage, duration of postoperative hospital stay, postoperative complications, postoperative crisis, CSR and effect etc. Results：There were significantly difference in duration of surgery [VATS group（1l0. 8±38. 06）rain VS TS group（199. 0±36. 05） min-] ,the intraoperative blood loss[VATS group（68. 5 ±16.22）ml VS TS group（205.8± 34.55）ml], the thoracic drainage volume of first-24-hours[VATS group（110. 0 ± 35.50）ml VS TS group（326.3±56.22）ml] ,the duration of chest drainages[VATS group（3.6±1.25）d VS TS group （5.6±1.19）d], the postoperative hospital stay[VATS group（9. 8±1.85） d VS TS group（16.1 ± 13. 3）d], The rate of pneumonia[VATS group 7.5% VS TS group 25.8 %]. However, there was no significantly difference between the CSR [VATS group 51% VS TS group 52. 9 %]. Conclusion：VATS treatment for the myasthenia gravis is technically feasi- ble and safe and is less invasive than TS thymectomy.