剑突肋缘下三孔式胸腔镜下胸腺切除治疗重症肌无力的早期临床疗效及对生活质量的影响

Early Clinical Efficacy and Impact on Quality of Life of Subxiphoid and Subcostal Three Ports Thoracoscopic Thymectomy for Myasthenia Gravis

目的:通过与传统单侧胸腔镜技术对比,探讨经剑突肋缘下三孔式胸腔镜下胸腺切除治疗重症肌无力的早期临床疗效及对患者生活质量的影响。方法:收集2012年1月-2016年6月因重症肌无力就诊于我院行胸腔镜下胸腺切除的115例患者。根据患者的手术方式分为传统单侧胸腔镜组47例和剑突肋缘下三孔式胸腔镜组68例,收集和比较两组患者的基本资料,包括性别、年龄、是否合并胸腺瘤、病程、随访时间、术前Osserman评分、手术时间、术中出血量、术后引流时间、术后引流量、转入ICU时间、术后住院时间、术后并发症的发生情况、术后不同时间点的疼痛评分和生活质量评分及末次随访时的愈后情况。结果:两组患者的年龄、性别比例、胸腺瘤情况、病程、随访时间和术前Osserman评分均没有差异(P>0.05)。三孔组手术时间、术中出血量、ICU停留时间和术后住院时间均短于或低于传统组(P<0.05)。两组患者术后并发症(膈神经麻痹、胸腔积液、伤口脂肪液化)发生率比较没有统计学差异(P>0.05)。三孔组患者在术后3天内和出院时的疼痛评分均显著低于传统组(P<0.05)。两组患者在末次随访时的有效率、术前、术后1年和末次随访时的生活质量评分(MGQOL-15评分)比较差异无统计学意义(P>0.05)。在三孔组患者末次随访时,女性MGQOL-15评分改善量(11.2±3.3分)高于男性(7.4±2.7分)(P<0.001)。Osserman评分3分和4分的患者MGQOL-15评分改善量(10.7±3.7分)显著高于Osserman评分2分的患者(5.0±1.9分)(P<0.001)。结论:经剑突肋缘下三孔式胸腔镜下切除胸腺治疗重症肌无力具有手术时间短、术中出血少、术后恢复快的特点,术后患者疼痛程度轻,生活质量改善明显。女性术后获益较男性更大。

Objective: To compare the early clinical efficacy of traditional unilateral thoracoscopic techniques and three ports thoracoscopic thymectomy in the treatment of myasthenia gravis and effect on the quality of life. Methods: From January 2012 to June 2016,115 patients with myasthenia gravis who underwent thoracoscopic thymectomy in our hospital were collected. According to the surgical procedure, 47 and 68 patients were divided into the traditional unilateral thoracoscopic group and the three ports thoracoscopic group under the xiphoid and costal margin respectively. The basic data including gender, age, thymoma, duration of disease, follow-up time and preoperative Osserman scores, the operation time, intraoperative blood loss, postoperative drainage time, postoperative drainage volume,ICU duration time, postoperative hospital stay, postoperative complications, pain scores, quality of life scores at different time points after surgery, and the post-hospital status at the last follow-up were reviewed and compared between two groups. Results: There was no differences in the age, sex ratio, thymoma status, duration of disease, follow-up time, and preoperative Osserman score between the two groups(P>0.05). The operation time, intraoperative blood loss, ICU duration time and postoperative hospital stay of three ports group were all lower than those of the traditional group(P<0.05). There was no significant difference in the incidence of postoperative complications(phrenic nerve palsy, pleural effusion, Wound fat liquefaction) between the two groups(P>0.05). The pain scores of three ports group were all significantly lower than those in the conventional group during 3 days after surgery and at discharge(P<0.05). There was no significant difference in the effective rate and quality of life scores(MGQOL-15 scores) at the preoperative, postoperative, and last follow-up between the two groups(P>0.05). At the last follow-up of the three ports group, the improvement in female MGQOL-15 score(11.2±3.3 points) was higher than that in men(7.4±2.7 points)(P<0.001). Patients with Osserman scores of 3 and 4 scored had significantly higher MGQOL-15 scores increment(10.7±3.7 points) than those with Osserman scores of 2(5.0±1.9 points)(P<0.001). Conclusions: Three ports thoracoscopic resection of the thymus under the xiphoid and costal margin has the characteristics of short operation time, less intraoperative blood loss and quick recovery after operation in the treatment of myasthenia gravis, it can effectively relieve the postoperative pain and improve the quality of life. Additionally, women benefit more than men.