胸腔镜经剑突下和经肋间入路胸腺扩大切除治疗重症肌无力的近期效果对比

Comparison of Short-term Efficacy of Video-assisted Thoracoscopic Extended Thymectomy Treating Myasthenia Gravis by Subxiphoid and Intercostal Approach

目的:评估胸腔镜经剑突下胸腺扩大切除治疗重症肌无力的安全性、有效性。方法:选取2016年3月-2020年8月在江门市中心医院确诊为重症肌无力的需行胸腺扩大切除术的80例患者。采用随机数字表法将患者分为剑突下组40例和经肋间组40例,并进行相应的胸腔镜手术切除。比较两组围手术期的各项指标(手术时间、手术出血量、术后引流量、胸管留置时间、术后住院时间、住院费用)、术后并发症发生情况(术后肺不张、术后出血、肺部感染、肌无力危象、心律失常)、术后疼痛评分及术后半年肌无力症状改善情况。结果:剑突下组的手术时间、胸管留置时间、术后住院时间均短于经肋间组,手术出血量少于经肋间组,差异均有统计学意义(P<0.05)。两组术后引流量、住院费用比较,差异均无统计学意义(P>0.05)。两组的肺不张、术后出血、肺部感染、肌无力危象、心律失常发生率比较,差异均无统计学意义(P>0.05)。两组皮肤穿刺的VAS评分比较,差异均无统计学意义(P>0.05)。术后第1、2、3、7、30、90天,剑突下组的VAS评分均优于经肋间组(P<0.05);术后第180天,两组VAS评分比较,差异无统计学意义(P>0.05)。术后半年的随访中,两组患者的肌无力症状改善情况比较,差异无统计学意义(P>0.05)。结论:经剑突下入路和经肋间入路胸腺扩大切除治疗重症肌无力在术后并发症和近期疗效方面情况相当,但经剑突下入路具有手术时间短、恢复快、术后疼痛轻的优点,值得临床推广。

Objective:To evaluate the safety and efficacy of video-assisted thoracoscopic extended thymectomy in the treatment of myasthenia gravis by subxiphoid approach.Method:A total of 80 patients with myasthenia gravis who were diagnosed in Jiangmen Central Hospital from March 2016 to August 2020 and needed extensive thymectomy were selected.The patients were divided into subxiphoid group(n=40)and intercostal group(n=40)by random number table method,and corresponding thoracoscopic resection was performed.The perioperative indexes(operation time,blood loss,postoperative drainage volume,chest tube indwelling time,postoperative hospital stay,hospitalization cost),postoperative complications(postoperative atelectasis,postoperative bleeding,pulmonary infection,myasthenic crisis,arrhythmia),postoperative pain score and improvement of myasthenic symptoms in half a year were compared between two groups.Result:The operative time,indwelling time and postoperative hospital stay of the subxiphoid group were shorter than those of the intercostal group,and the amount of surgical blood loss was less than that of the intercostal group,the differences were statistically significant(P<0.05).There were no significant differences in postoperative drainage volume and hospitalization cost between two groups(P>0.05).There were no significant differences in the incidence of atelectasis,postoperative hemorrhage,pulmonary infection,muscle weakness crisis and arrhythmia between two groups(P>0.05).There was no statistical significance in the VAS scores of skin puncture between two groups(P>0.05).On day 1,2,3,7,30 and 90 after surgery,the VAS scores of the subxiphoid group were better than those of the intercostal group(P<0.05).On day 180 after surgery,there was no significant difference in VAS scores between two groups(P>0.05).There was no statistically significant difference in the improvement of myasthenia symptoms between two groups during the follow-up of 6 months after surgery(P>0.05).Conclusion:Extensive thymectomy with a subxiphoid approach and a intercostal approach for myasthenia gravis has similar postoperative complications and short-term outcomes.However,the subxiphoid approach has the advantages of short operation time,quick recovery and less postoperative pain,it is worthy of clinical promotion.