经剑突下达芬奇机器人手术与传统胸腔镜手术治疗重症肌无力合并胸腺瘤的对比研究

Comparison of perioperative outcomes of robotic trans-subxiphoid and video-assisted thoracoscopic extended thymectomy in the treatment of myasthenia gravis complicated with thymoma

目的比较经剑突下达芬奇机器人胸腺扩大切除术(SRAET)和传统胸腔镜胸腺扩大切除术(VATET)治疗重症肌无力合并胸腺瘤的围术期疗效及安全性。方法回顾性分析2017年1月至2019年6月四川大学华西医院胸外科连续收治的重症肌无力合并胸腺瘤患者61例。所有患者行胸腺扩大切除术,按手术方式不同将患者分为SRAET组和VATET组。SRAET组26例,男11例、女15例,平均年龄(42.20±13.20)岁;VATET组35例,男14例、女21例,平均年龄(45.00±13.00)岁。比较两组患者手术时间、术中出血量、中转开胸率、胸腔引流管拔除时间、引流量、术后视觉模拟评分、住院时间、术后并发症等围术期指标。结果两组均无中转开胸、死亡病例或重症肌无力危象发生。两组患者手术时间[(111.42±28.60)min vs.(103.71±26.20)min,P=0.845]、术中出血量[(32.31±23.84)mL vs.(63.57±132.22)mL,P=0.239]、术后胸腔引流量[(206.85±130.09)mL vs.(276.86±173.46)mL,P=0.089]、拔管时间[(2.54±0.81)d vs.(2.26±0.82)d,P=0.187]、平均住院时间[(5.81±2.52)d vs.(5.29±2.17)d,P=0.642]、术后并发症发生率(3.8%vs.2.9%,P=0.675)、术后24 h VAS评分[(2.46±0.76)分vs.(2.40±0.74)分,P=0.751]和术后48 h VAS评分[(2.12±0.77)分vs.(2.26±0.56)分,P=0.407]差异均无统计学意义;SRAET组术后72 h疼痛评分显著低于VATET组[(1.12±0.65)分vs.(1.86±0.91)分,P=0.001]。结论SRAET可达到和VATET一致的安全性和有效性,并且术后短期疼痛较轻,是一种治疗重症肌无力合并胸腺瘤的可选手术方法。

Objective To compare the perioperative outcomes of subxiphoid robot-assisted extended thymectomy(SRAET)and video-assisted thoracoscopic extended thymectomy(VATET)for myasthenia gravis complicated with thymoma.Methods Retrospective analysis of 61 patients with myasthenia gravis combined with thymoma who were admitted to the Department of Thoracic Surgery,West China Hospital,Sichuan University from January 2017 to June 2019 was performed.All patients underwent extended thymectomy,and the patients were divided into a SRAET group and a VATET group.There were 26 patients in the SRAET group,including 11 males and 15 females,with an average age of 42.20±13.20 years.There were 35 patients in the VATET group,including 14 males and 21 females,with an average age of 45.00±13.00 years.The perioperative outcomes of the two groups including gender,age,operation time,intraoperative blood loss,conversion rate,postoperative drainage,tube removal time,drainage volume,visual analogue scale,hospital stay and postoperative complications were compared.Results There was no conversion to thoracotomy,death or myasthenia crisis in both groups.The operation time(111.42±28.60 min vs.103.71±26.20 min,P=0.845),intraoperative blood loss(32.31±23.84 mL vs.63.57±132.22 mL,P=0.239),visual analogue scale at postoperative24 h(2.46±0.76 vs.2.40±0.74,P=0.751)and postoperative 48 h(2.12±0.77 vs.2.26±0.56,P=0.407),complication rate(3.8%vs.2.9%,P=0.675),drainage volume(206.85±130.09 mL vs.276.86±173.46 mL,P=0.089)and hospital stay(5.81±2.52 d vs.5.29±2.17 d,P=0.642)were not significantly different between the two groups.The visual analogue scale of the SRAET group at postoperative 72 h(1.12±0.65 vs.1.86±0.91,P=0.001)was significantly lower than that of the VATET group.Conclusion SRAET is a safe and feasible method with less postoperative short-term pain,which is an alternative surgical treatment for myasthenia gravis complicated with thymoma.