腹腔镜Toupet和Nissen胃底折叠术治疗难治性胃食管反流病的疗效对比

目的 对比腹腔镜Toupet和Nissen胃底折叠术治疗难治性胃食管反流病(rGERD)的临床疗效。方法回顾性分析2014年12月至2019年1月陆军军医大学第三附属医院胸外科收治的74例进行腹腔镜胃底折叠术的rGERD患者的临床资料。其中44例患者行Toupet胃底折叠术(Toupet组),30例患者行Nissen胃底折叠术(Nissen组)。比较2组患者术前与术后高分辨率食管测压、24h监测pH、GERD-Q量表评分及围术期恢复情况。结果2组患者均无死亡及重大并发症,术后患者反流症状较术前均明显缓解,差异有统计学意义(P<0.05)。2组患者术后DeMeester评分、食管下括约肌压力(LESP)、完整松弛压力(IRP)、食管远端收缩积分平均值(DCI)、总反流次数、GERD-Q量表评分较术前均明显改善,差异有统计学意义(P<0.05)。2组患者手术时间、术中出血量、术后禁食时间、住院时间比较差异无统计学意义(P>0.05);Toupet组术后出现吞咽困难2例(4.5%),Nissen组出现吞咽困难7例(23.3%),2组比较差异有统计学意义(P<0.05)。结论腹腔镜Toupet和Nissen胃底折叠术都是治疗rGERD安全有效的手术方式,但Toupet术式术后吞咽困难发生率低于Nissen术式。

电磁导航支气管镜在肺周围型病变诊断中的应用

目的探讨微创诊疗技术电磁导航支气管镜(ENB)活检在肺周围型病变(PPL)诊治中的应用。方法回顾性分析我院胸外科2016年6月至2017年12月施行ENB活检的29例PPL患者的临床资料。利用ENB进行术前病理活检及病变定位,根据定位在电视胸腔镜下对标记位置进行精准切除。结果每个病灶ENB活检取样3块,操作时间(31.2±6.5)min,术中失血量(4.1±1.6)mL。总体诊断率79.3%,肿瘤确诊率78.9%。ENB联合PET可使总体诊断率提升至86.2%。不同病灶大小、不同肺叶PPL活检成功率比较,差异无统计学意义(P>0.05)。操作过程中无气胸、大出血及气管损伤。结论利用ENB技术诊断PPL技术精度高,具有较高的阳性率,并发症发生率低,可一站式完成诊断及定位。

Predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy

Background Thymectomy is considered the most effective treatment in patients with myasthenia gravis. This study aimed to explore the predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy.Methods Clinical records of 243 patients with myasthenia gravis who underwent thymectomy were reviewed retrospectively. The following factors were analyzed in relation to the occurrence of myasthenic crisis after thymectomy：gender, age, duration of symptoms, Osserman stage, history of myasthenic crisis, concomitant diseases, preoperative pyridostigmine dose, preoperative steroid therapy, operation approach, operation time, presence of thymoma, major postoperative complications.Results Forty-four patients experienced postoperative myasthenic crisis during the first month after thymectomy.Univariate analysis revealed that Osserman stage （RR=0.0976, P=0.000）, history of myasthenic crisis （RR=0.2309,P=0.012）, preoperative pyridostigmine dose （RR=0.4349, P=0.016）, thymoma （RR=0.0606, P=0.000）, and major postoperative complications （RR=0.1094, P=0.000） were significantly related to postoperative myasthenic crisis.Multivariate Logistic regression analysis showed that Osserman stage （Ⅱb＋Ⅲ＋Ⅳ） （RR=0.0953, P=0.000）, thymoma （RR=0.0294, P=0.000）, and major postoperative complications （RR=0.0424, P=0.000） independently predict postoperative myasthenic crisis.Conclusion Osserman stage （Ⅱb＋Ⅲb＋Ⅳ）, thymoma and major postoperative complications are independent predictors of postoperative myasthenic crisis in patients with myasthenia gravis who underwent thymectomy.