经剑突下胸腔镜胸腺切除治疗眼肌型重症肌无力的疗效分析及对术后应激反应的影响

Extended thymectomy in treating ocular myasthenia gravis and its effect on postoperative stress response

目的探讨经剑突下胸腔镜下胸腺切除治疗眼肌型重症肌无力的临床疗效及其对术后应激反应的影响。方法选取2014年1月至2016年5月海南省人民医院收治的眼肌型重症肌无力病人64例,根据病人意愿及治疗方法不同分为观察组32例与对照组32例,对照组采取传统正中胸骨开胸手术治疗,观察组采取经剑突下电视胸腔镜手术治疗。比较两组术后治疗效果及应激反应相关指标。结果观察组手术时间(108.8±20.5)min、手术失血量(75.8±26.9)mL、胸腔总引流量(212±72.9)mL均明显低于对照组(129.2±24.2)min、(145.7±23.4)mL、(373.3±86.8)mL,术后肺功能恢复迅速,术后并发症少,均差异有统计学意义(P<0.05);术后5、15 d疼痛评分更低,差异有统计学意义(P<0.05);两组术后肌无力危象、术后第1天疼痛评分、住院时间和总有效率(80.0%比75.86%)均差异无统计学意义(P>0.05)。在应激反应方面,术后1、3、5 d血清中炎症因子C反应蛋白(CRP)、白细胞介素?6(IL?6)、肿瘤坏死因子?α(TNF?α)、白细胞介素?1β(IL?1β)的含量,观察组均较对照组明显降低,均差异有统计学意义(P<0.05);术后1、3、5 d血清中应激激素皮质醇(Cor)、血管紧张素(AT?II)及前列腺素E2(PGE2)的含量,与对照组比较,观察组的含量均明显降低,差异有统计学意义(P<0.05)。结论经剑突下胸腔镜下手术治疗眼肌型重症肌无力临床疗效好,创伤小、恢复迅速、治疗效果可靠,有效地减轻病人术后全身炎症及应激反应,有利于术后快速康复,值得临床推广应用。

Objective To investigate the clinical efficacy of subxiphoid video?assisted thoracoscopic extended thymectomy in treat?ing ocular myasthenia gravis and its effect on postoperative stress response,and to provide a reference for clinical treatment.Meth?ods 64 patients with ocular myasthenia gravis treated in our department of thoracic surgery from January 2014 to May 2016 were selected and divided into observation group(n=32)and control group(n=32)according to patient’s choices and treatment meth?ods.The control group was treated with conventional median sternotomy,and the observation group was treated with subxiphoid vid?eo?assisted thoracoscopic surgery.The clinical effects and stress response related indexes of the two groups were compared after op?eration.Results Compared with the control group,the observation group showed,in a significant manner,less operation time[(108.8±20.5)min vs.(129.2±24.2)min]and fewer blood losses[(75.8±26.9)mL vs.(145.7±23.4)mL],lower total thoracic drain?age volume[(212±72.9)mL vs(.373.3±86.8)mL],rapider recovery of postoperative pulmonary function and fewer postoperative com?plications,and the differences were statistically significant(P<0.05).The pain scores on the 5th day and 15th day after surgery were lower than the control group,and the difference was statistically significant(P<0.05).The postoperative myasthenia crisis,postoper?ative pain score,hospital stay and total effective rate(80.0%vs.75.86%)on the 1st day after surgery in either group showed no sig?nificant differences(P>0.05).In terms of stress response,postoperatively,the content of serum inflammatory factors including C?re?active protein(CRP),interleukin?6(IL?6),tumor necrosis factor?α(TNF?α),interleukin?1β(IL?1β)on the 1st,3rd and 5th day after surgerypresented a significantly lower trend than that of the control group,and the difference was statistically significant(P<0.05).Compared with the control group,the observation group indicated a significant decrease in the content of postoperative stress hormone cortisol(Cor),angiotensin II(AT?II)and prostaglandin E2(PGE2)in serum on the 1st,3rd and 5th day after surgery,which showed significant statisticaldifferences(P<0.05).Conclusion The subxiphoid video?assisted thoracoscopic surgery in treating ocular myasthenia gravis shows a better clinical curative effect. It has the advantages of small trauma,rapid recovery andreliable therapeutic effect,which may effectively alleviate postoperative systemic inflammation and stress response. It is conduciveto rapid recovery for patients after surgery and worthy of clinical expansion.