右腋下入路术与胸骨入路术对小儿先心病的效果分析

目的右腋入路术与胸骨入路术对小儿先天性心脏病(先心病)的效果分析。方法选取116例先心病患儿,按照随机数字表法分为胸骨入路组和右腋入路组,每组58例。胸骨入路组实施胸骨入路手术,右腋入路组实施右腋下入路手术,比较两组的治疗效果及手术并发症发生情况。结果在不同手术入路下,右腋入路组的手术时间、体外循环时间、主动脉阻断时间与胸骨入路组比较,差异无统计学意义(P>0.05);右腋入路组的术中出血量、胸腔引流量、辅助通气时间、住院时间、术后30 min、术后2 h的VAS评分和VSS评分均低于胸骨入路组(P<0.05);右腋入路组的RR、VA、A-aDO2、MVV与胸骨入路组比较,差异无统计学意义(P>0.05);右腋入路组的并发症发生率低于胸骨入路组(P<0.05)。结论右腋下小切口入路手术的效果更佳、安全性更高。

胸骨正中劈开入路治疗缩窄性心包炎临床分析

目的 :探讨手术治疗缩窄性心包炎的最佳手术径路。方法 :对 1978年来收治的缩窄性心包炎 10 6例病人行手术治疗 ,其中经左胸前外侧切口入路 6 6例 ,经胸骨正中劈开入路 40例 ,对 10 6例病的手术及术后疗效、并发症进行回顾性分析。结果 :经左胸前外侧切口手术治愈率为 34.9% (2 3/ 6 6 ) ,胸腔及肺部感染发生率高 ,死亡率为 6 .1% (4 / 6 6 ) ,经胸骨正中劈开入路手术治愈率为 87% (35 / 40 ) ,无胸腔感染并发症及死亡。结论 :经胸骨正中劈开入路心包显露充分 ,心包切除松解彻底 ,且避免进入胸腔而发生并发症 ,为治疗缩窄性心包炎的最佳手术径路。

经胸腔镜胸腺扩大切除治疗胸腺瘤并重症肌无力的临床研究

目的比较在胸腺瘤并重症肌无力中应用胸腔镜入路、胸骨正中入路胸腺扩大切除术的疗效。方法选取2017年3—10月昌乐县人民医院及潍坊市人民医院联合收治的64例胸腺瘤并MG患者临床资料,按术式不同分两组,各组32例,对照组行胸骨正中入路胸腺扩大切除术,观察组行胸腔镜入路胸腺扩大切除术,比较组间手术指标、并发症及疗效。结果观察组手术时间(139.21±52.11)min、术中出血量(78.42±56.23)mL、切口大小(5.15±0.30)cm、胸腔引流时间(2.46±1.71)d、ICU监护时间(10.41±4.82)h、引流量(177.52±19.40)mL、住院时间(6.12±2.21)d均比对照组优(P<0.05);观察组术后并发症发生率6.25%比对照组28.13%低(P<0.05);观察组手术治疗MG总有效率90.63%比对照组65.63%高(P<0.05)。结论胸腺瘤并MG行胸腔镜入路胸腔扩大切除术治疗能有效缓解肌无力,降低术后并发症,且手术安全性高。

扩大胸腺切除术治疗重症肌无力的临床研究

目的:探讨重症肌无力的外科治疗和围术期处理方法。方法:采取扩大的胸腺切除和纵隔脂肪组织清扫手术治疗重症肌无力89例,其中单纯重症肌无力48例,胸腺瘤合并重症肌无力41例,其中1例伴发甲状腺机能亢进,27例有肌无力危象发作史。Osserman分型:Ⅰ型21例,Ⅱa型17例,Ⅱb型31例,Ⅲ型15例,Ⅳ5例。1987年以前手术采用前胸二或三肋间横切口或右胸前外侧切口入路手术。1988年以后采用胸骨正中入路施术。术前均口服吡啶期的明每天180～600mg分次服用,Ⅱb型以上病加服强的松每天30～60mg或90mg隔日一次顿服。手术当日和术后抗胆碱酯酶药物给药的剂量、方法、时间不变。术日激素采用氢考300～400mg静滴。危重病人采取预防性气管切开或延迟气管插管和呼吸机辅助呼吸,以帮助病人渡过手术创伤期和危象发生期。结果:全组13例术后12～22小时之间发生肌无力危象,死亡3例,死亡率3.4％。其余均治愈出院。对32例病人随访12个月～120个月,缓解6例,明显改善13例,改善4例,无效1例,差2例,失访6例。结论:正中入路施行扩大胸腺切除和纵隔脂肪组织清扫效果可靠,围术期合理抗胆碱酯酶药物和激素是手术成功的前提,适时的气管切开和延迟气管插管拔管行呼吸机辅助呼吸为病人提供了渡过手术创伤期的安全保证。

胸腺切除术治疗重症肌无力的长期随访:胸腔镜手术与开胸术的比较

Purpose: The aim of this study was to determine if patients are in remission or weaning off medication after thymectomy for myasthenia gravis (MG) and to examine the thoracoscopic versus open approaches. Methods: A retrospective review of all patients who underwent thymectomy for MG at a tertiary referral center between 1992 and 2004 (N = 14). Six patients (42.9%) underwent thoracoscopic resection. Eight patients underwent open resection; 5 (35.7%) had median sternotomy and 3 (21.4%) by transcervical approaches. Follow-up was obtained in 12 (85.7%) of 14 patients by both chart review and telephone. The mean follow-up was 43.0 months (range, 4-111 months). Statistical significance was determined by Student’s t test or Fisher’s Exact Test. Results: The thoracoscopic group had a mean operating time of 138.8 minutes compared with 139.8 minutes in the open group (P = .9). The thoracoscopic group had a mean estimated blood loss of 7.5 mL compared with 52.5 mL in the open group (P = .02). The mean length of stay for the thoracoscopic group was 1.5 days (range, 1-2 days) and was 10.6 days (range, 3-41 days) in the open group (P = .13). Three (60%) of 5 patients were entirely off medication in the thoracoscopic group at the time of follow-up compared with 3 (50%) of 6 patients in the open group (P = 1.0). In the thoracoscopic group, 5 (83.3%) of 6 were in class 1 to 3 of the DeFilippi classification (compl-ete remission or improved with decreased medication requirements). One patient had no change in symptoms (class 4). In the open group, 5 (83.3%) of 6 were classified as DeFilippi 1 to 3 at the time of follow-up, and one patient had worsening symptoms (class 5). Conclusions: Both thoracoscopic and open approaches to thymectomy in patients with MG are effective, with more than 80%of patients in both groups in remission or with improvement at the time of follow-up. The thoracoscopic group has the added benefits of decreased estimated blood loss, decreased length of hospital stay, and improved cosmesis. We advocate the thoracoscopic approach for thymectomy in the treatment of juvenile MG.