电视胸腔镜与传统开胸手术治疗Ⅰ型重症肌无力疗效比较

Comparison on the clinical efficacy of video-assisted thoracoscopic surgery and traditional open thoracic surgery in the treatment of type Ⅰ myasthenia gravis

目的探讨电视胸腔镜手术治疗Ⅰ型重症肌无力患者的疗效。方法回顾分析海南医学院附属医院2011年3月至2015年8月期间行胸腺切除手术的82例Ⅰ型重症肌无力患者的临床资料,其中胸腔镜组38例,开胸组44例。比较两组患者的一般情况、免疫指标、应激反应、并发症及临床疗效。结果胸腔镜组在手术时间、术中出血量、切口长度、总住院时间、带管时间分别为(90.2±22.7)min、(50.4±28.1)m L、(3.0±0.5)cm、(2.1±1.1)d、(7.0±2.6)d,低于开胸组的(100.6±22.3)min、(150.6±50.1)m L、(13.0±5.1)cm、(7.2±2.8)d、(9.3±2.8)d,差异均有统计学意义(P<0.05);术毕,胸腔镜组的CD4、CD8值分别为(39.74±6.48)、(31.76±3.42),高于开胸组的(35.62±5.61)、(30.94±5.42);术后24 h胸腔镜组的CD3值为(50.08±3.33),高于开胸组的(45.55±3.84);术后48 h胸腔镜组的CD8、HLA-DR分别为(30.6±8.49)、(69.10±8.44),高于开胸组的(28.11±4.65)、(61.03±6.50);术后24 h、48 h胸腔镜组去甲肾上腺素(NE)浓度分别为(360.71±25.08)、(284.66±25.08),低于开胸组的(406.88±32.75)、(360.67±30.25),差异均有统计学意义(P<0.05);胸腔镜组术后并发症发生率为26.3%(10/38),低于开胸组的63.6%(28/44),差异有统计学意义(P<0.05)。结论电视胸腔镜手术治疗Ⅰ型重症肌无力疗效优于开胸组,其具有免疫功能抑制轻、应激反应小的特点,术后并发症发生率更低,是治疗Ⅰ型重症肌无力的较好选择。

Objective To explore and analyze the clinical effects of video-assisted thoracoscopic surgery(VATS) for the treatment of type Ⅰ myasthenia gravis. Methods The clinical data of eighty-two patients of type Ⅰ myasthenia gravis undergoing thoracic surgery in our hospital from March 2011 to August 2015 were analyzed, including38 patients treated with VATS(VATS group) and 44 patients treated with open thoracic surgery(open group). The general situation, immune factor, stress response, complications and treatment effect of two groups were compared. Results The operation time, intraoperative bleeding volume, wound length, hospitalization time, tubulization time in VATS group were(90.2±22.7) min,(50.4±28.1) m L,(3.0±0.5) cm,(2.1±1.1) d,(7.0±2.6) d respectively, which were significantly lower than(100.6±22.3) min,(150.6±50.1) m L,(13.0±5.1) cm,(7.2±2.8) d,(9.3±2.8) d in open group(P<0.05). After surgery,CD4, CD8 levels in VATS group were(39.74±6.48),(31.76±3.42), significantly higher than(35.62±5.61),(30.94±5.42)in open group. 24 h after surgery, CD3 level of patients in VATS group was higher than that in open group with(50.08 ± 3.33) vs(45.55 ± 3.84), and CD8, HLA-DR levels 48 h after surgery in VATS group were higher than those in open group with(30.6±8.49) vs(28.11±4.65) and(69.10±8.44) vs(61.03±6.50). Norepinephrine(NE) level at 24 hours and 48 hours postoperatively in VATS group were significantly lower than those in open group((360.71 ± 25.08) vs(406.88±32.75),(284.66±25.08) vs(360.67±30.25), P<0.05). The complication rates of VATS group was 26.3%(10/38),significantly lower than 63.6%(28/44) of open group(P<0.05). Conclusion VATS is superior to open thoracic surgery in the treatment of type Ⅰ myasthenia gravis, with less postoperative complications, lighter immune suppression, and smaller stress response.