电视胸腔镜与胸骨劈开胸腺扩大切除治疗重症肌无力疗效比较研究

A Comparative Study of the Efficacy between Video-assisted Thoracoscopic and Transsternalthymectomy for the Treatment of Myasthenia Gravis

目的比较电视胸腔镜手术(VATS)与胸骨劈开胸腺扩大切除治疗重症肌无力的近期和中远期疗效。方法本院53例诊断为非胸腺瘤重症肌无力(MG)并接受胸腺扩大切除术的患者。其中胸腔镜下完成38例,胸骨正中劈开完成15例。所有患者术后都接受电话随访,随访时间超过3年。结果全组无重大手术并发症及围手术期死亡,VATS组术后出现1例(2.6%)肌无力危象,开胸组术后4例(26.7%)出现肌无力危象。与开胸组比较,VATS组术中出血量更少,(88.1±34.1)ml Vs(352.5±97.0)ml,两组比较差异有显著性(P<0.001);术后住院时间更短(6.8±2.0)天Vs(9.5±3.7)天,两组比较差异有显著性(P<0.001);手术时间两者之间无明显差异。VATS组术后平均随访48.3(38-98)个月,术后症状缓解率94.7%,其中完全缓解率63.1%,与胸骨劈开组(80.0%,13.3%)比较差异无显著性(P>0.05)。结论胸腔镜胸腺扩大切除术较开胸手术有更好的围手术期疗效,远期疗效两者相当,术中操作的规范性是保证手术质量的关键。

Object＇re To compare the short term and long term efficacy of VATS thymectomy （Video-assisted thoracoscopic, VATS） and trans-sternal thymectomy for treatment of myasthenia gravis. Methods We retrospectively reviewed 53 patients with non-thymomatous Myasthenia gravis. 38 cases underwent VATS thymectomy, 15 cases underwent trans-sternal thymectomy. All patients were followed up for more than 3 year..Results There was no serious complication and perioperative death in the whole group. One case of postoperative neurological crisis was found in the VATS group. Compared with the thoracotomy group, VATS group had few amount of blood loss, （88.1±34.1） ml Vs （352.5±97.0）ml, the difference between the two groups was significant （P〈0.001）, shorter postoperative stay in hospital （6.8±2.0） days Vs （9.5±3.7）days, there is significantly different between two groups （P〈0.001）, there is no significantly difference in operating time. In VATS group, the mean follow-up was 48.3 （38-98） months. The partial remission rate was 94.7%, and the complete remission rate was 63.1%, which was not significantly different from that in thoracotomy group （80.0%, 13.3%） （P〉0.05）. Conclusion VATS thymetomy has a better perioperative effect than thoracotomy thymetomy, and the long-term efficacy is comparable. Standard operation is the key to ensuring the quality of surgery.