胸腔镜与经胸骨切除胸腺手术治疗重症肌无力的疗效比较

Comparison of the treatment of thoracoscopic or Trans-sternal thymectomy for myasthenia gravis

目的通过与经胸骨切除胸腺手术对比,探讨胸腔镜胸腺切除术在治疗重症肌无力中的安全性及可行性。方法回顾性分析2008年1月至2015年12月于中日友好医院胸外科行胸腺切除术的62例重症肌无力患者的临床及病理资料。结果 62例患者中,38例(61.3%)行胸腔镜胸腺切除术,24例(38.7%)行经胸骨胸腺切除术。胸腔镜手术组患者术中出血量少于传统组,差异有统计学意义(P<0.05)。术后带管时间、术后住院时间均短于传统组(P<0.05)。而手术时间、术后引流量及术后并发症发生率两组无明显差异(P>0.05)。手术总有效率在两组MG患者之间无明显差别(83.3%vs.88.9%,P=0.962)。结论电视辅助胸腔镜技术对于重症肌无力的疗效不差于传统经胸骨手术,且具有出血少、损伤小及住院时间短等优点,值得临床推广使用。

Objective To investigate the safety and feasibility of thoracoscopic thymectomy in the treatment of myasthenia gravis compared with trans-stemal thymectomy. Methods Retrospectively analyzed the clinical and pathological data of 62 patients with myasthenia gravis admitted in the Department of thoracic surgery of China-Japan Friendship Hospital from January 2008 to December 2015. Results In 62 cases, 38 （61.3%） underwent thoracoscopic thymectomy, 24 cases （38.7%） underwent transstemal thymectomy. The intraoperative bleeding in Thoracoscopic surgery group was less than the traditional group, the difference was statistically significant （P 〈 0.05）, and postoperative intubation time, postoperative hospitalization time was shorter than the traditional group （P 〈 0.05）. The operative time, postoperative drainage and postoperative complications of the two groups had no significant difference （P 〉 0.05）. The total efficiency was no significantly different between the two groups of patients with MG （83.3%vs88.9%, P = 0.962）. Conclusion The effect of video-assisted thoracoscopic surgery for myasthenia gravis is not inferior to that of the traditional Transsternal thymecto- my, and it has the advantages of less bleeding, less injury and shorter hospital stay, therefore, it is worthy of clinical application.