双侧同期小单孔VATS与传统VATS对MG治疗的对比研究

Comparative study of one stage and bilateral uniportal-video-assisted thoracic surgery versus traditional video-assisted thoracic surgery in the treatment of myasthenia gravis

目的 探讨双侧同期小单孔胸腔镜两侧胸腺及纵隔脂肪切除治疗重症肌无力（MG）的安全性及有效性.方法 回顾性分析2009年2月至2013年12月收治的131例行电视胸腔镜手术（VATS）治疗重症肌无力（myasthenia gravis,MG）的患者资料,其中2009年2月至2012年3月行传统的三孔VATS组76例,行单侧胸腺及纵隔脂肪切除;2012年4月至2013年12月行双侧同期小单孔VATS组55例,行双侧胸腺及纵隔脂肪切除.比较两组患者的手术时间、术中出血量、术后胸腔引流管放置时间、术后疼痛评分、术后住院时间、术后并发症、肌无力症状缓解率、肌无力危象发生率等临床资料.结果 两组患者一般情况及病理类型无统计学差异,131例患者均手术顺利.双侧同期小单孔胸腔镜双侧胸腺及纵隔脂肪切除组,较传统三孔胸腔镜单侧胸腺及纵隔脂肪切除组手术时间稍长,但术后疼痛更轻,住院时间更短.两组患者在出血量、胸管引流量和引流时间上差异无统计学意义.随访32～ 90个月,131例患者中完成随访118例（90.08％）,小单孔组症状缓解率94.5％（52/55）,三孔组症状缓解率84.2％（64/76）,且小单孔组肌无力危象较三孔组减少,差异有统计学意义,P＜0.05.结论 双侧同期小单孔 VATS行双侧胸腺及纵隔脂肪切除,在技术上是安全、可行的,与传统三孔VATS单侧胸腺及纵隔脂肪切除相比,手术时间稍长,但胸腺及脂肪切除更加彻底,患者疼痛更轻,住院时间更短,肌无力缓解率更高,肌无力危象发生率降低.

Objective To investigate the security and efficacy of one stage and bilateral resection of thymic tissue and clearance of mediastinal fat by uniportal-video-assisted thoracic surgery（VATS） to cure patients with myasthenia gravis（MG）.Methods A number of 131 patients with MG who underwent resection of thymic tissue and clearance of mediastinal fat by VATS in one single center from February 2009 to December 2013 were selected in this retrospective study.76 patients underwent unilateral resection of thymic tissue and clearance of mediastinal fat by three portal VATS from February 2009 to March 2012 and 55 patients underwent one stage and bilateral resection of thymic tissue and clearance of mediastinal fat by small uniportal-VATS from April 2012 to December 2013.The time for operation,the bleeding volume during operation,the volume of postoperative drainage and drainage time,the improvement of symptoms,the postoperative pain,hospital stays and the occurrence of myasthenia gravis crisis were compared between the two groups.Results The general condition and pathological type did not have significant statistical differences between the two groups.The operating time in the uniportal-VATS group was significantly longer than that in three portal VATS group,but the pain was lighter,and the hospital stay was shorter.There were no significant differences between groups in terms of blood loss,postoperative drainage time,and volume of drainage.The follow-up was from 32 to 90 months,and 118 （90.08%）patients completed the follow up.94.5 % of the patients in uniportalVATS group acquired complete stable remission（CSR）,while it was 84.2% in three portal VATS group（P 〈 0.05）,and the uniportal-VATS group had lower rate of myasthenic crisis （P 〈0.05）.Conclusion One stage and bilateral resection of thymic tissue and clearance of mediastinal fat by small uniportal-VATS is safe and effective with shorter hospital stay and less pain,and it can get higher CSR and less myasthenic crisis,its efficacy is superior to traditional three portal VATS.