中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

不同种手术方式治疗胸腺瘤合并重症肌无力的比较

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目的 比较不同手术方式治疗胸腺瘤合并重症肌无力,探讨胸腔镜联合纵隔镜胸腺扩大切除术的临床疗效。 方法 回顾性分析 2011 年至 2016 年江苏省苏北人民医院收治的胸腺瘤合并重症肌无力的患者 58 例。根据手术方式分为三组:A 组(胸腔镜组)32 例,B 组(胸腔镜联合纵隔镜组)15 例,C 组(经胸骨正中劈开组)11 例。观察比较各组患者术中出血量、胸腺清扫程度、术后症状缓解率等相关指标。 结果 在手术出血量、术后住院时间和总并发症发生率上,A 组和 B 组均显著小于 C 组 (p<0.05);B 组的肌无力危象发生率(6.7%) 小于 C 组(36.4%),但差异无统计学意义(PB-C=0.058>0.05);三组的手术时间分别为 122.0±39.4 min,130.3±42.5 min,142.3±40.8 min,组间差异无统计学意义 (p>0.05);B 组的清扫程度(1 级,12 例,80.0%)显著大于 A 组(1 级,14 例,43.8%)(p<0.05);三组的术后有效率分别为 84.4%,93.3%,90.9%,组间差异无统计学意义 (p>0.05)。 结论 胸腔镜联合纵隔镜胸腺扩大切除术不仅具有创伤小、术后恢复快、并发症少等优势,而且能更为彻底地清扫胸腺及脂肪组织,能达到与胸骨正中劈开术式相当的治疗效果。

Objective To compare the different surgical treatment of thymoma combined with myasthenia gravis(MG), discuss the clinical effect of thoracoscopic combined mediastinoscopy thymus enlargement resection. Methods A retrospective analysis of 58 cases of thymoma combined with myasthenia gravis in Northern Jiangsu People's Hospital from 2011 to 2016 was conducted. According to the operation method, the patients were divided into three groups: group A for thoracoscopic thymectomy (n=32), group B for thoracoscopic combined mediastinoscopic thymectomy (n=15), group C for transsternal thymectomy (n=11). The intraoperative blood loss, thymus clearance, postoperative symptom relief rate and other related indicators were observed and compared. Results In group A and group B, the bleeding volume, postoperative hospital stay and other complications were significantly lower than those in group C (p<0.05); The incidence of myasthenic crisis in group B (6.7%) was less than that in group C (36.4 %), but the difference was not statistically significant (PB-C = 0.058> 0.05); The operation time of the three groups were 122.0 ± 39.4 min, 130.3 ± 42.5 min and 142.3 ± 40.8 min, there was no significant difference between the two groups respectively (P>0.05); The cleaning dissecting ranges in group B (grade 1, 12 cases, 80%) was significantly greater than that in group A (1, 14, 43.8%) (p<0.05); The effective rates of three groups were 84.4%, 93.3% and 90.9%, respectively, and there was no significant difference between groups (p>0.05). Conclusion The thoracoscopic combined mediastinoscopic thymectomy not only has the advantages of less trauma, quick recovery and fewer complications, but also can more thoroughly clean the thymus and adipose tissue, which can achieve the same therapeutic effect as the transsternal thymectomy.

关键词: 胸腺瘤; 重症肌无力; 胸腔镜联合纵隔镜; 胸腺切除术

Key words: Thymoma; myasthenia gravis; thoracoscopy combined with mediastinum; transsternal

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